Long-term results of operative therapy for aortoiliac disease.

Over a period of 11 1/2 years, 140 patients were operated on for aortoiliac disease; 81 had coexisting superficial femoral artery occlusions (combined segment disease). Patients with combined segment disease were older, had twice the incidence of diabetes, and significantly more rest pain and gangrene on presentation. Aortic bifurcation grafts were placed in 114 patients. Relief of rest pain and threatened gangrene was uniformly good. However, relief of claudication was significantly poorer in patients with combined segment disease. There were 11 "late" thrombotic graft occlusions. Six grafts with distal anastamoses to the external iliacs failed because of limb outflow problems, while five grafts to the common femoral position exhibited more diffuse problems. Late graft failures were due to progression of disease and not problems intrinsic to the grafts. Cumulative patency rates were 98.0% at one year and 94.6% at three years.