Reoperation following failure of aortoiliofemoral arterial reconstruction.

Over a 19-year period, 729 primary arterial reconstructions for aneurysmal and occlusive disease of the aortoiliac arterial system were performed at the Health Sciences Centre, Winnipeg. During the same interval 49 of these reconstructions required reoperation and 6 additional cases were referred for secondary repair from other institutions. The authors reviewed these 55 cases to determine the reasons for reoperation and the cumulative results of secondary repair. Secondary arterial repair was performed in 11.5% of cases of occlusive disease and in 1.2% of cases of aneurysmal disease. The overall frequency of reoperation was 6.7%. The mean interval between primary and secondary operation was 31.5 months. Perioperative failure, false aneurysm, graft infection, progression of disease and late technical problems were the major reasons for reoperation. Of the secondary repairs the results in 83.6% were satisfactory at 30 days. At 5 years, 57% of secondary repairs at risk remained satisfactory. The operative mortality for secondary arterial repair was 5.4%. The authors believe that continued aggressive management of failed primary aortoiliac reconstructions is justified.