In Reply.—Dr Gaylis offers three additional possible causes for occlusions of aortic bifurcation grafts. I must emphasize that we almost never perform end-to-side anastomoses to the aorta proximally. With regard to the tunnel for extension of the limb to the femoral artery, it obviously has to be ample, permitting two fingers through very readily. Therefore, we have not considered this as an important cause of chronic occlusion. In relation to the last comment pertaining to runoff, we did mention that patients with concomitant superficial femoral occlusion had a higher incidence of limb thrombosis as compared with those who had no additional obstructive lesions distal to the aortoiliac system.
I certainly agree that it would have been interesting to have correlated the incidence of thrombosis with the clinical manifestations of the disease. I think it would be higher in patients presenting with advanced ischemia or nutritional deficit as compared with