21 Thirty Year Trends in Aortofemoral Bypass for Aortoiliac Occlusive Disease скачать в хорошем качестве

21 Thirty Year Trends in Aortofemoral Bypass for Aortoiliac Occlusive Disease

#AortofemoralBypass #ABFB #AortoiliacDisease #VascularSurgery #Endovascular #SurgicalTrends #Patency #Outcomes #Training This video examines a 2018 study on 30-year trends (1985-2015) in aorto-bifemoral bypass (ABFB) for aortoiliac occlusive disease (AOD). This traditional open surgery creates a detour around blockages. The study investigated how the widespread adoption of less invasive endovascular treatments (angioplasty, stents) impacted ABFB patients and outcomes by comparing a historical cohort (pre-widespread endo) to a contemporary cohort (endo is common). Key shifts in the contemporary patient group included significantly more women and smokers, but most notably, a much larger percentage had previously failed an endovascular procedure on the same arteries. This suggests ABFB is increasingly reserved for more complex cases or as a bailout after less invasive methods fail. Despite this increased complexity, the immediate safety remained high, with 30-day mortality staying very low (1%) in both groups. Interestingly, 10-year survival was significantly higher in the contemporary group, likely due to overall improvements in medical care, such as managing cardiac risk factors. However, graft durability, measured by primary patency, was slightly lower in the contemporary cohort (82% vs. 93% at five years). Predictors of lower patency and major adverse limb events included being in the contemporary group, younger age, prior open aortic surgery, and using a smaller graft diameter. Despite the slight drop in primary patency, ABFB remains incredibly effective, particularly for limb salvage in critical ischemia (98% in the contemporary group). Its durability remains crucial, especially for extensive disease or failed endo procedures, making it a vital skill in vascular surgery. The evolving patient mix highlights the ongoing need to maintain expertise in complex open procedures.