19 The Natural History of Bilateral Aortofemoral Bypass Grafts for Ischemia of the Lower Extremities скачать в хорошем качестве

19 The Natural History of Bilateral Aortofemoral Bypass Grafts for Ischemia of the Lower Extremities

#AortofemoralBypass #AFBG #VascularSurgery #Ischemia #LimbSalvage #Patency #OutflowDisease #LandmarkPaper #MaloneMooreGoldstone #OpenSurgery This video deep dive explores the pivotal 1975 paper by Malone, Moore, and Goldstone on the natural history of bilateral aortofemoral bypass grafts (AFBG) for severe leg ischemia. Published at a time when surgeons debated AFBG versus aortoiliac endarterectomy, this study provided crucial long-term data on AFBG durability. Endarterectomy avoided artificial material but seemed less durable downstream. Looking at 180 patients (360 graft limbs), the paper reported a remarkable 99.2% immediate graft patency. Ten-year cumulative patency was 66%, considered encouraging for severe disease. The study identified key predictors of graft failure: significant blockages in the profunda femoris artery and tibial trifurcation vessels further down the leg. The strongest link was disease in both areas simultaneously, creating back pressure. Limb salvage rates were also impressive: 94% immediately and 85% at 10 years, highlighting the surgery's ability to save legs. Symptom relief strongly correlated with graft patency. Operative mortality was low for the era at 2.5%. Later reflections by author Jerry Goldstone reinforce these findings and add context. He stressed the importance of addressing profunda origin narrowing during surgery and noted that standard angiography then missed many such blockages. While the study had limitations (retrospective, single centre), it firmly established AFBG as a highly successful and durable treatment that became the standard for decades. Today, the landscape has shifted dramatically with the rise of less invasive endovascular techniques (angioplasty, stents), particularly for the iliacs. This has reduced the number of open AFBG procedures performed, raising concerns about maintaining training and expertise in complex open surgery. Without robust, long-term comparative data between modern endovascular methods and the proven durability of AFBG documented in studies like this, some argue AFBG remains the benchmark. This video is part of a series summarising chapters from the book "50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know".