Open surgical treatment of total occlusions of the abdominal aorta

Objectives: To analyze the perioperative results and\r\nlong-term follow-up of open surgery among patients with\r\na total chronic occlusion of the abdominal aorta.\r\nMaterial and methods: The data from 87 consecutive\r\npatients treated by open surgery for a total occlusion of\r\nthe abdominal aorta in our center between 1998 and\r\n2018 were collected prospectively. Thirty-nine patients\r\npresented a distal infrarenal aortic occlusion and 48 a proximal juxta/suprarenal occlusion. A thrombosed infrarenal\r\naneurysm was associated in five cases. In eight cases a\r\nprevious endovascular approach failed. 48 patients had\r\nan aorto-bifemoral bypass, 15 patients had a thrombo-endarterectomy and an enlargement angioplasty, and 24 patients had an extra-anatomical bypass (including 20\r\ncases with axillo-bifemoral bypass and four cases of thoraco-bifemoral bypass). A suprarenal clamping was necessary in 28 cases (32.2%) of abdominal aortic surgery. Two\r\ncases required an aorto-renal bypass for aortic lesions\r\nextending up to the ostium of a renal artery. One case\r\nrequired a bypass to treat a preexistent occlusion of the superior mesenteric artery.\r\nResults: Perioperative morbidity included cardiac (3.4%)\r\nand respiratory (2.3%) complications, as well as acute\r\nimpaired renal function (2.3%). The significant renal complications were reported only in case of suprarenal crossclamping. After an average follow-up of 74 months we\r\nobserved primary and secondary patency rates of 94.3%,\r\n92% and 88.5% at 12, 24, and 36 months, respectively.\r\nIn the cases treated by thrombo-endarterectomy and\r\nenlargement angioplasty there was no arterial thrombosis.\r\nIn the patients with a preoperative renal malperfusion we\r\nobserved an improvement of the renal function and of the\r\ncontrol of arterial hypertension or visceral ischemic symptomatology in all the cases.\r\nConclusion: Open surgical treatment of the total occlusions of the abdominal aorta offers an acceptable rate\r\nof mortality and morbidity and an excellent long term\r\npatency especially in the cases of direct aortic surgery.\r\nIn the event of a proximal obstruction the need for a suprarenal clamping and repair of the renal arteries is often\r\nnecessary.