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Journal of Vascular Diseases and Treatment

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Classical open aorto-bi-femoral grafting is a gold standard technique in aorto-iliac occlusive disease: The technique of double layered reinforcing aorto-graft proximal anastomosis with anterior augmentation patchplasty and its advantages

Author(s): Arun Kumar Haridas* and Bharathi Shridhar Bhat

Introduction: Incidence of peripheral vascular disease has increased worldwide. It is associated with significant morbidity and mortality. Infra renal aorto-iliac occlusive disease is the commonest subset. This subset can be associated with or without distal vessels involvement. It is critical to manage such cases earliest, to salvage the limbs and to avoid the mortality. Classical open aorto bi femoral grafting is the gold standard technique. Endovascular stenting has been slowly but steadily, accepted in selective cases of AIOD. Less heard laparoscopic and robotic assisted surgery, practised in a small series of cases but they are yet to prove themselves. Proximal anastomotic technique is varied with surgeons. Individual techniques have their own merits and demerits.

Objective: To study the patients presenting with aorto-iliac occlusive disease and their outcome after open aorto bi femoral grafting using proximal, side to end double layered reinforced aorto-graft anastomosis with anterior augmentation patchplasty. We reviewed and compared our technique with other contemporary techniques available for AOID.

Method: We did a retrospective study of patients from December 2014 to December 2017 suffering from aorto-iliac occlusive disease and outcome of open aorto bi femoral grafting using proximal, side to end double layered reinforced aorto-graft anastomosis with patchplasty technique. Case history was reviewed in detail about the nature of group and way of their presentations. Computed tomograms, coronary angiograms of peripheral and coronary vessels were evaluated to study pattern of disease along with associated distal vessels involvement. All patients underwent classical open aorto bi femoral grafting using the technique of proximal, side to end double layered reinforced aorto-graft anastomosis with anterior augmentation patchplasty with or with distal bypass. Post-op outcome, complications and patency of graft was evaluated over the period of 3 years.

Result: The majority of the patients were less than 60 years with the male predominance. Smoking was strongly associated co morbid condition. Smokers had bad non graft able vessels requiring more grafts. Delayed presentation with pre-gangrene or gangrene had an increased incidence of morbidity and mortality. Technique of open aorto Bi femoral grafting using proximal, side to end double layered reinforced aorto-graft anastomosis with anterior augmentation patchplasty is superior in reducing post-op complication and it allows graft to stay parallel to native vessels so, avoids the distortion or kinking of the graft. Dacron graft had the higher incidence of early and late graft occlusion and needed redo surgery.

Conclusion: Infrarenal aorto occlusive disease is second commonest subset of peripheral vascular disease. Classical open aorto bi femoral grafting is the gold standard technique. Laparoscopic and endovascular surgeries are suitable in very selective patients. Technique of open aorto bi femoral grafting using proximal, side to end double layered reinforced aorto-graft anastomosis with anterior augmentation patchplasty is superior in reducing complications and increasing greater patency rate. PTFE graft has the better long-term patency rate. The incidence of the redo surgeries were higher with Dacron grafts compared to PTFE grafts.


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