Aorto-iliac occlusive disease

Changes in cardiac output during major vascular surgery

The largest decrease in cardiac output in patients undergoing aortoiliac bypass grafting for peripheral arterial occlusive disease occurs when the aorta is cross-clamped, not when it is declamped. This decrease was reduced in four patients who received 2 liters of Ringer's lactate preoperatively. Postoperatively, as peripheral resistance decreases, a large volume of fluid may be necessary to maintain homeostasis. By knowing when changes in cardiac hemodynamics can be expected to occur during aortoiliac surgery, it may be possible to prevent cardiac complications.

Thromboendarterectomy combined with femoropopliteal bypass

Most complications that appear within 5-6 weeks after femoropopliteal bypass (FPB) are associated with the surgical procedure in the groin. Destruction of lymphatic structures in the presence of an open foot infection and crushing of the intima by clamping the common and deep femoral arteries are significant predisposing factors in producing early infection or occlusion of the graft. To avoid these predisposing factors, a combined procedure of a short thromboendarterectomy of the proximal superficial femoral artery and an autogenous or prosthetic bypass graft was used, without application of clamps to the common and deep femora arteris. In a series of 45 patients, this combined procedure was used and a significant reduction of complications was achieved. Indications, technique, and advantages of this combined method are discussed.

Late complications of abdominal aortic reconstructive surgery: roentgen evaluation

During a 5-year period from 1969 to 1974, 53 (8.5%) of 631 patients developed late complications following abdominal aortic reconstructive surgery. Occlusion was the most frequent complication and occurred in 4%. Others included stenosis, false aneurysm, enteric fistula and infection. Late complications were demonstrated by roentgenographic methods. Angiography was the most valuable roentgen study. It is indicated in all patients suspected of having delayed complications except those with unstable life-threatening hemorrhage. Additional roentgenographic studies including the barium enema and barium meal may help make the diagnosis and exclude other entities. In any patient with an abdominal aortic graft and gastrointestinal bleeding, the diagnosis of an aorto-enteric fistula should be considered until otherwise proven.