Occlusion of the aortofemoral prosthetic graft.

The commonest late complication of aortofemoral prosthetic grafting is graft-limb occlusion, the usual cause of which is outflow obstruction due to anastomotic neointimal hyperplasia or progressive atherosclerosis in the deep femoral artery. Occasionally graft-limb occlusion is due to thrombosis of an anastomotic false aneurysm or is associated with graft infection. Inflow occlusion at the aortic anastomosis is uncommon unless the aortic anastomosis is at the lower end of the aorta distal to the inferior mesenteric artery. When graft-limb occlusion occurs, severe ischemia usually necessitates urgent revascularization to save the leg. Graft thrombectomy and profundaplasty may be successful; however, a cross-femoral graft to the distal patent deep femoral artery is probably the simplest procedure and is usually effective. Occasionally a distal femoropopliteal reconstruction is necessary to establish a satisfactory outflow. Unsuccessful reconstruction of a graft-limb occlusion usually necessitates a high, above-knee amputation.