Risk factors of major perioperative complications of surgical reconstruction for atherosclerosic aortoiliac occlusion

Objective:Aortoiliac occlusion is commonly seen in disease of arteriosclerotic obliterans of lower extremities.Management comprises endovascular treatment and traditional graft bypass.Endovascular treatment is applied more widely and dramatically decreases the risk of perioperative mortality and complication.But for long lesion and severe calcification,graft bypass is still the main procedure.This study was to analyse risk factors impacting on perioperative morbidity and mortality of selective surgical reconstruction for arteriosclerotic aortoiliac occlusion.Methods:Between January 1990 and July 2009,173 patients underwent aortoiliac revasculararization for arteriosclerotic aortoiliac occlusion at Anzhen hospital.Data of pre-and perioperation were retrospectively reviewed.Patient demographics,selected risk factors,perioperative mortality,major complications,clinic status change of lower extremity ischemia were recorded.Multivariate analyses were performed with logistic regression to assess risk factors such as age,surgical option,major organ function,that may affect mortality and major complications within 30 days.Major organ functions were assessed by SVS(Vascular Surgery/International Society for Cardiovascular Surgery) report standardization.According to SVS criteria,cardiac,pulmonary,renal status,carotid diseasewere graded in severity with uniform definitions for(1) mild,(2) moderate,and(3) severe.Criteria for reporting significant change in clinical status of lower extremities used SVS report standardization.Results:There were 159 male and 14 female.Median age was 61.03 years(range 35-81).Anatomic procedure was performed in 75 patients,including 13 cases of aortoiliac bypass and 62 cases of aortofemoral bypass.Extra-anatomic bypass were performed in 98 patients,including 33 cases of femofemoral bypass and 65 cases of axillofemoral bypass.Major perioperative complications occured in 13.5% of patients undergoing surgical reconstruction,including ischemic heart disease in 6 patients,heart failure in 6,stroke in 5,renal failure in 2,pulmonary failure in 6,thrombosis of graft and embolism in 8,intestinal obstruction in 3 patients.Age(OR = 8.435,95% CI = 1.836-38.760,P = 0.006),SVS kidney status(OR =2.56,95%CI =1.12-28.02,P =0.024)、SVS cardic status(OR =5.605,95% CI =1.690-18.595,P = 0.005)、SVS pulmonary status(OR = 3.663,95% CI = 1.134-11.829,P = 0.03)、surgical method(OR = 0.154,95% CI = 0.033-0.713,P = 0.017) were identified as risk factors of perioperative major complications.Perioperative mortality was 6.4%.Age(OR = 100.21,95% CI = 4.085-2 475.56,P = 0.005)、SVS cardic status(OR = 11.91% CI = 1.872-75.73,P = 0.009)、surgical method(OR = 0.003,95% CI = 0.001-0.107,P = 0003)、emphysema(OR = 7.548,95% CI = 1.63-34.93,P = 0.01) were predictive of perioperative death.There was no significantly difference of symptom improvement between anatomic and extra-anatomic group(P = 1.00).Conclusion:Patients with arteriosclerosic aortoiliac occlusion are often elders with high risk of perioprative morbidity.Patients with age more than 70 years,SVS cardic status higher than grade 2,SVS pulmonary status higher than grade 3,SVS kidney status higher than grade 3,have higher perioperative risk of major complication and mortality.To those patients,comprehensive preoperative evaluation and more cautious perioperative monitoring,proper surgical decision may be helpful to reduce perioperative morbidity and mortality.