Aortoiliac reconstruction in obese patients.

In the patient with limb-threatening ischemia and aortoiliac occlusive disease surgical reconstruction with a prosthetic bypass, because of its safety and durability, has emerged as the treatment of choice. In obese patients, however, such therapy might be eschewed because of the frequent coexistence of multiple risk factors and the large size of these patients. In ten obese patients who had limb-threatening ischemia or rapidly worsening disabling claudication and aortoiliac occlusive disease, direct aortoiliac reconstruction was performed. There were no perioperative deaths, and only one major complication occurred in this group. The cumulative 5-year graft limb-patency and limb-salvage rates were each 90%. Despite the higher risk and unusual technical challenges that obese patients may present, direct reconstruction is the preferred treatment for aortoiliac occlusive disease and limb-threatening ischemia.