Combined infrarenal aorta and carotid artery reconstruction: early and late outcome in 152 patients.

Between January 1, 1985 and December 31, 1998, we performed combined infrarenal aorta and carotid artery reconstruction in 152 consecutive patients. The mean age of these patients was 65.4 +/- 8.6 years (range, 43-88 years). Infrarenal aortic disease involved abdominal aortic aneurysm in 78 patients (44.7%) and occlusive aortoiliac lesions in 84 (55.3%). Carotid artery disease was detected by performing routine Doppler ultrasonography prior to aortic reconstruction. A total of 121 carotid lesions were asymptomatic (79.6%). A total of 32 patients (21%) had a history of contralateral carotid repair. Eighty-one patients (53.2%) presented with coronary artery disease diagnosed on the basis of clinical and/or laboratory testing. Concurrent lesions were diagnosed in the renal arteries of 43 patients (28.3%) and in the visceral arteries of 16 (10.5%). Based on the results of cardiac evaluation, eight patients underwent coronary revascularization before combined reconstruction. Renal or visceral artery reconstruction was carried out during the same procedure in 30 (19.7%) and 10 (6.6%) patients, respectively. Univariate analysis demonstrated six factors that were significantly associated with perioperative mortality and morbidity: age, coronary artery disease, chronic obstructive pulmonary disease, procedure time, intraoperative blood loss, and creatinemia over 140 micromol/L. Multivariate analysis showed that only the first four of these factors were independent. Actuarial survival in the overall population, including the patients who died during the perioperative period, was 73.9 +/- 7.1% at 5 years and 50.9 +/- 10% at 10 years. From our experience, we conclude that combined infrarenal aorta and carotid artery reconstruction can be performed with no additional operative risks and consequently is the strategy of choice. In our series neither procedure had any effect on the early or late outcome of the other. Our experience suggests that combined surgery is a safe alternative to staged surgery in patients with concurrent lesions involving the infrarenal aorta and carotid artery bifurcation.