[Aortofemoral bypass and extensive profunda-plasty in combined arterial occlusive disease of the pelvic-femoral type--a stage oriented analysis].

121 patients with multilevel, lower extremity arterial occlusive disease were treated by aortofemoral reconstruction and extended profundoplasty. Early and late results of 201 limbs were analyzed according to their preoperative grade of ischemia. In the case of moderate claudication the success rate was 43% postoperatively and 81% after 5 years. When having severe claudication the success rate was 62% and 79% after 5 years. The revascularisation of the deep femoral artery helps developing the collateral arteries, responsible for an improvement after a considerable period of time. In limbs with rest pain we got a success rate of 78% postoperatively and 76% after 5 years. In the case of gangrene the primary success rate was 40% and 68% after 5 years. Angiographically, severe arteriosclerotic lesions were documented in the deep femoral artery and popliteal artery when limb-threatening ischemia was present. Nevertheless, the combined aortofemoral and extended deep femoral artery reconstruction was efficient in treating the multilevel occlusive disease; subsequent femoro-distal bypass was necessary only in case of threatening ischemia for 9.3% of limbs. Our findings show there is no indication for simultaneous aortofemoral and femoro-distal bypass grafting in the treatment of the multilevel disease.