Preoperative diagnosis and management of the hypoplastic vessel syndrome.

From 1972 to 1979, 142 aortofemoral bypass grafts were carried out with 5 failures. In 3 of the cases the etiological factor appeared to be hypoplasia of the vessels. After reviewing the charts and arteriograms of the other patients, a further 9 cases in the hypoplastic category were collected. The mean age of the patients was 57 years, all were smokers and 3 were diabetic. Three patients had hyperlipidemia. The 12 patients falling into the hypoplastic group had mean diameter of the aorta of 1.1 cm. The diameter of the femoral artery was 3 mm. From the aortograms done on 20 patients without evidence of vascular disease, the average diameter of the aorta was 1.97 cm. In 20 patients with aorto iliac disease the aorta measured 1.9 cm and the common femoral artery 9 mm. A comparison was made of the ratio of the aorta to the transverse diameter of the vertebral body. In the hypoplastic patient the percentage was 22% and in patients with aorto iliac disease 39.5%. Hypoplasia appears to involve both the aorta and the distal vessels. Although variations in the size of the aorta and its branches are common, these patients with hypoplastic vessels appear to form a distinct group. This group of patients are high risk in terms of surgery. The importance of pre-operative diagnosis is stressed and a method of diagnosing the situation pre-operatively is described.