Összefoglaló. Bevezetés: A diffúz aortobiiliacalis érszakasz occlusiv betegségének kezelésére alkalmazott aortobifemoralis bypass szerepe csökken az endovascularis műtétek térnyerése miatt. Célkitűzés: A vizsgálat célja volt a modern invazív kezelés korszakában a perioperatív és a hosszú távú eredmények elemzése aortobiiliacalis bypass után, melyek összehasonlíthatók az endovascularis megoldások eredményeivel. Módszerek: A retrospektív, egycentrumú vizsgálat során a Semmelweis Egyetem Városmajori Szív- és Érgyógyászati Klinikájának Érsebészeti és Endovaszkuláris Tanszékén 2006. 01. 01. és 2017. 12. 31. között occlusiv aortoiliacalis atherosclerosis miatt primer aortobifemoralis bypass műtéten átesett 419 beteg (átlagéletkor: 62,2 év, SD: ± 8,22; 224 férfi, 53%) adatait elemeztük. Eredmények: A posztoperatív 30 napon belüli mortalitás 5,01%, a késői mortalitás 10,98% és 29,59% volt 12, illetve 60 hónap után. A betegek 12,57%-ánál történt korai reoperáció, késői reoperáció 32 (8%) betegnél vált szükségessé. A graft elsődleges nyitva maradása 88,65% és 81,15% volt 12, illetve 60 hónap után. 21 betegnél történt amputáció (6,29%); 57,14%-ban femoralis, 35,71%-ban cruralis szinten, 7,14%-ban a boka szintje alatt. Az amputációkra 35,71%-ban a bypasst követő 30 napon belül, további 35,71%-ban 2 éven belül került sor. Az esetek 35,63%-ában lépett fel egyéb szövődmény; a leggyakoribbak: műtétet igénylő posztoperatív hernia (6,89%), cardiovascularis szövődmény (4,19%), lágyéki nyirokcsorgás vagy sebgyógyulási zavar (4,79%). Következtetés: Eredményeink alapján e betegcsoportban az aortobifemoralis bypass elfogadható, de nem jelentéktelen perioperatív halálozással és magas morbiditással jár. A graft hosszú távú nyitva maradása jó, de az újabb érműtét mind rövid, mind hosszú távon relatíve gyakori. A kevésbé invazív technikák eredményeinek összehasonlítása indokolt a hosszú szakaszú (TASC C, D) elváltozások esetén. Orv Hetil. 2021; 162(3): 99–105. Summary. Introduction: The role of aorto-bifemoral bypass in the treatment of diffuse aorto-biiliac occlusive disease decreases in the era of endovascular surgery. Objective: The aim of the study was to analyse the early and long-term postoperative results of aorto-bifemoral bypass in a recent time period. These results may be used as a baseline to compare the results of endovascular procedures. Methods: In a retrospective, single-center study, the data of 419 patients (mean age: 62.2 years, SD: ± 8.22; 224 men, 53%) who underwent primary aorto-bifemoral bypass due to occlusive aorto-iliac atherosclerosis from 01. 01. 2006 to 31. 12. 2017 at the Department of Vascular and Endovascular Surgery of Semmelweis University Heart and Vascular Center were analysed. Results: Postoperative mortality within 30 days was 5.01%, late mortality was 10.98% and 29.59% after 12 and 60 months, respectively. 12.57% of the patients needed early reoperation and late reoperation was required in 32 cases (8%). The primary graft patency was 88.65% and 81.15% after 12 and 60 months, respectively. 21 patients underwent amputation (6.29%); 57.14% at the femoral level, 35.71% at the crural level and 7.14% below the ankle level. Amputations were performed in 35.71% of the cases within 30 days after the bypass and an additional 35.71% within 2 years. Other complications occurred in 35.63% of the cases; the most common causes were postoperative hernia requiring surgery (6.89%), cardiovascular complication (4.19%) and inguinal wound healing disorders (4.79%). Conclusion: Based on our results, aorto-bifemoral bypass surgery is associated with acceptable but not insignificant perioperative mortality and high morbidity in this group of patients. The graft patency is favourable in the long term, however, additional vascular reintervention is common in short and long term as well. Short- and long-term results of percutaneous endovascular techniques in diffuse aorto-biiliac disease (TASC C and D lesions) are suggested to be compared to these recent results of open surgery. Orv Hetil. 2021; 162(3): 99–105.

Introduction Femoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15–45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI. Aims Our objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts. Methods Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017. Results During a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years. Conclusion Allograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.

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