[Transplant occlusion following aortofemoral bifurcation bypass: causes, therapeutic measures and results].

35 patients with graft thrombosis following aortobifemoral bypass grafting were analysed retrospectively (1971-1983). In 24 of these patients aortobifemoral bypass graft was performed in our own hospital and the thrombosis rate was 9.1%. 40 bypass branches and 54 graft occlusions were involved. Late occlusions were more common (75.9%), occurring after an average time interval of a little more than 5 years. Inadequate peripheral run-off with progression of the atherosclerosis was the cause in 37.5%. In 40.0% the site of occlusion was in the proximal segment of the graft, where kinking related to anastomotic technical problems played a major role. The transfemoral ring or balloon thrombectomy was successful in 45.5%. In 24.2%, however, this had to be combined with a bypass procedure (femoropopliteal or femorocrural). A change of the graft was indicated in 48.5%, but this was considered too risky in 30.3% (extraanatomic bypass: change of graft = 1.7:1). In the case of poor distal run-off a peripheral corrective procedure was a must for graft patency. In every second patient this could be achieved by profunda revascularisation. Occlusions at the central bifurcation segment are better prevented by proper anastomotic techniques. A graft with a short main trunk anastomosed to the high infrarenal aortic segment ensures a safer anastomosis and a proper position of the graft branches with little possibility of kinking. Since the routine use of this method a graft thrombosis caused by central technical problems has not been seen.