[Role of extra-anatomical bypasses in the treatment of aorto-iliac occlusion].

In the last six years we have performed 468 operations because of aortoiliac occlusion or septic complications of these arteries. 410 (87.6%) of these operations were anatomical reconstructions, in 58 (12.4%) patients we performed extra anatomical bypasses. The distribution of the operations was the following; 12 obturator, 23 femoro-femoral crossover, 13 axillofemoral and 10 axillobifemoral bypasses. The indication for extra-anatomical reconstruction in 24 (41.4%) patients was septic complication (EABS), and in 34 cases (58.6%) poor general condition or difficulties during surgery. The average age of the patients with non-septic indication (EABNS) was significantly higher than the average age of the patients treated with anatomical reconstruction (AR) (66.3 vs. 60.9 year, p < 0.01). There were more REDO operations in the group EABNS then in the AR group (35.3%/11.7% p < 0.02). Despite of the high operative risk, the rate of early complications (EABNS 13.8%, AR 10%) and postoperative mortality (EABNS 3.7%, AR 4.0%) was not statistically different between the two groups. If the indication was aorto-duodenal fistula (6 patients) or acute limb ischaemia (7 patients), the mortality was significantly higher compared to other extra-anatomical operations (46.2% vs. 4.4%, p < 0.01). The postoperative mortality after EABNS and EABS operations was similar (11.7% vs. 16.6%), but we performed more reoperations after EABS operations (10/24 vs. 2/34, p < 0.05). According to our early postoperative results elective extra-anatomical bypasses are suitable for the treatment of aortoiliac occlusion in high risk patients, with poor life expectancy. Extra-anatomical bypasses are performed because of acute ischemia or septic complications which are life or limb threatening complications, so early results must be validated concerning this fact.