Cumulative patency and actual palliation in patients with claudication after aortofemoral bypass. Prospective long-term follow-up of 100 patients.

This report assesses patency, subsequent surgery, and the effect of late mortality in a series of 100 consecutive aortofemoral grafts performed for significant claudication on the basis of aortoiliac occlusive disease. Considering thrombosis or elective revision as failure, the primary patency rate at 5 and 10 years was 84 percent and 78 percent, respectively. However, most of these grafts were easily revised and remained patent for long periods, giving a secondary patency rate of 93 percent at 10 years. But survival is the critical factor in assessing what has really been accomplished for these patients. We believe that this is best expressed by cumulative actual palliation, that is, the patient alive, the graft patent, and the symptoms controlled without amputation. Cumulative actual palliation was approximately 75 percent at 5 years and 50 percent at 10 years. The palliation index (the proportion of living patients who were palliated) was more than 90 percent throughout the first 10 years. These data support the use of aortofemoral grafting in selected patients who suffer from intermittent claudication. Reporting the cumulative actual palliation, palliation index, and salvage index add precise and useful information to cumulative graft patency that disregards the effect of death.