Extra-Anatomic Bypass Operation for Aorto-Iliac Disease in Poor Risk Cardio-Pulmonary Patients

Abstract

Three years experience with subcutaneous axillo-femoral and bifemoral bypass surgical procedures has been outlined in patients with poor cardio- pulmonary and other risk related factors. Special emphasis has been made regarding technical consideration; advantages and disadvantages have been discussed. There were 49 limbs at risk in this group of 27 patients requiring axillo-bifemoral in 22, and axillo-unifemoral in 5. Sixty-three percent of pa tients had associated arteriosclerotic heart disease and 48% had severe em physema. There were 3 peri-operative deaths for 11% hospital mortality and 3 late deaths (12.5%). Six of the remaining patients for whom long term follow-up is available, acute graft thrombosis occurred in 3 patients salvaged by graft thrombectomy and 4 patients had late thrombosis resulting in 3 permanent graft failures. Two patients required above the knee amputation. Limb salvage and relief of lower extremity ischemic pains has been gratifying. During the limited follow-up period from 1-36 months (Mean 18) there is 87% patency rate for 43 grafts to 43 limbs.

Get full access to this article

View all access options for this article.

References

Blaisdell FW , and Hall AD : Axillary-Femoral Bypass for Lower Extremity Ischemia. Surg 54:563, 1963.

Parsonnett V. , Alpert J. , and Brief D. : Femero-Femoral and Axillo-Femoral Grafts . Compromise or Preference. Surg 67:26, 1970.

Lamis PA , Stanton PE , Wilson JP , and Let-ton H. : Axillo-Femoral and Femero-Femoral Bypass Grafts. Southern Med J 66:1263, 1973.

Pierangeli A. , Guernelli N. : The Axillo-Femoral Bypass As a Treatment of the Obstruction of the Aorto-Iliac Junction in the Poor Risk Patients. J Cardiovasc Surg 8:353, 1967.

Lord Rsa , Tracy GD : Subcutaneous Axillo-Femoral and Femero-Femoral Arterial Grafts in the Poor Risk Patients Med J Aust 2:997, 1971.

Bliss BP , Barrett GS : Axillo-Femoral and Axillo Profunda Bypass Grafts. Ann of Royal Coll of England 50:268, 1973.

Moore WS , Hall AD , Blaisdale, WF : Late Results of Axillary-Femoral Bypass Grafting. The Am J of Surg 122:148, 1971.

Eugene J. , Goldstone J. , Moore WS : Fifteen Year Experience With Subcutaneous Bypass Grafts For Lower Extremity Ischemia. Ann of Surg 186:177, 1977.

Logefro FW , Johnson WC et al: A comparison Of the Late Patency Rates Of Axillo-Bilateral Femoral and Axillo-Unilateral Femoral Grafts. Surg 81:33, 1977.

10.

Johnson WC , Logefro FW , et al: Is Axillo-Bilateral Femoral Graft an Effective Substitute for Aortic-Bilateral Iliac/Femoral Graft? Annals of Surg 186:123, 1977.