Occlusion of aortofemoral bifurcation grafts: how to improve the results?

Forty-three patients with graft occlusion after aortofemoral bifurcation bypass surgery were analysed (1971-1986, 52 bypass branches, 75 graft occlusions). The late occlusion dominated with 73.1%. A poor run off was the main reason in 40.4%. A reduced inflow was responsible in 36.6%, especially caused by graft kinking. Bypass thrombectomy was performed in 56.7%, in 35.8% in combination with a distal reconstruction. Graft exchange was indicated in 39.6% but in 25.6% extraanatomical reconstruction was performed due to a high risk situation. Perioperative mortality rate measured 13.9%, not depending on the surgical procedures. Four times a major amputation was unavoidable. Therefore, in nine patients (= 20.9%) extremity or life could not be preserved. The rate of bifurcation graft occlusions can be reduced by technical improvement of the proximal anastomosis as to the mentioned guidelines.