Open surgical treatment of total occlusions of the abdominal aorta

Objectives: To analyze the perioperative results and long-term follow-up of open surgery among patients with a total chronic occlusion of the abdominal aorta. Material and methods: The data from 87 consecutive patients treated by open surgery for a total occlusion of the abdominal aorta in our center between 1998 and 2018 were collected prospectively. Thirty-nine patients presented a distal infrarenal aortic occlusion and 48 a proximal juxta/suprarenal occlusion. A thrombosed infrarenal aneurysm was associated in five cases. In eight cases a previous endovascular approach failed. 48 patients had an aorto-bifemoral bypass, 15 patients had a thrombo-endarterectomy and an enlargement angioplasty, and 24 patients had an extra-anatomical bypass (including 20 cases 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 cases required an aorto-renal bypass for aortic lesions extending up to the ostium of a renal artery. One case required a bypass to treat a preexistent occlusion of the superior mesenteric artery. Results: Perioperative morbidity included cardiac (3.4%) and respiratory (2.3%) complications, as well as acute impaired 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 observed primary and secondary patency rates of 94.3%, 92% and 88.5% at 12, 24, and 36 months, respectively. In the cases treated by thrombo-endarterectomy and enlargement angioplasty there was no arterial thrombosis. In the patients with a preoperative renal malperfusion we observed an improvement of the renal function and of the control of arterial hypertension or visceral ischemic symptomatology in all the cases. Conclusion: Open surgical treatment of the total occlusions of the abdominal aorta offers an acceptable rate of mortality and morbidity and an excellent long term patency especially in the cases of direct aortic surgery. In the event of a proximal obstruction the need for a suprarenal clamping and repair of the renal arteries is often necessary.