PART THREE CHAPTER 6
at 1 year and 50% at 3 years.31,32 Very limited data are available concerning axillopopliteal bypasses in AGI. Seeger et al11 reported a primary patency of 0% at 7 months, secondary patency 53% at 17 months, and 27% at 50 months in five axillopopliteal bypasses constructed in AGI. There is no consensus in the literature about the use of oral anticoagulation and its influence on patency rates.
Complications Amputation Amputation rates are influenced by patency and concomitant peripheral ischemic disease. Most publications use amputation rates as a marker for morbidity. Published amputation rates are reported in Table 3. Stump blowout Aortic stump disruption by mechanical or infectious causes has always been a dreaded complication associated with EAB. Adequate closure of the aortic stump after graft excision is essential but can pose quite a challenge because of the inflamed tissue and fragile aortic wall. Various techniques have been proposed to ensure stump integrity. These include double sutures using a single-ply reinforcement with venous or felt pledgets, double-plane sutures, reinforcement with the prevertebral fascia, and also interposition of a protective fringe of epiploon.7,16-19,22 To further reinforce the aortic stump, the use of an omental wrap, if available and technically possible, is recommended.7,16-19,22 There is no evidence on the real positive or negative influence of omentum on the incidence of stump disruption.
Table 3 Amputation rates for extra-anatomic bypass (EAB) Author
Publication year
Patients (n)
Follow-up (mean, months)
Amputation rate (%)
Yeager19
1990
38
NS
21
Ricotta10
1991
32
34
13
Olah8
1992
12
20
0
Lehnert
1993
21
24
24
Sharp20
1994
22
NS
0
Kuestner22
1995
33
53
6
Yeager21
1999
60 (58 EAB)
41
10
Seeger
2000
36
32
11
Hart24
2005
15
14
7
Oderich7
2006
43
41
9
Brown25
2009
18
14
6
18
11
NS: not stated
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