A Twenty-Year Experience with Axillofemoral Bypass: Analysis of 63 Consecutive Cases

Abstract

The results of 63 consecutive axillofemoral bypass grafts are presented.

A computerized analysis of the data was performed according to the possible variables apt to influence the results of the reconstruction: different indications, stage of disease, previous reconstructions, presence of graft infection, unilateral or bilateral revascularization, iliac artery and runoff status, and graft caliber and material. A higher five-year graft patency rate was obtained with bypasses performed in poor-risk patients with occlusive arterial disease (axillounifemoral graft: 53.7%; axillobifemoral graft: 41.6%) than in procedures performed in emergency (p < 0.025) or for infection of previous vascular reconstructions (p < 0.001). There was a similar five-year patency rate in axillounifemoral and axillobifemoral grafts (p = NS) and in the bypasses performed in patients with iliac artery occlusion or stenosis (p = NS). A higher patency rate was obtained when there were two or three patent tibial vessels (p < 0.001). Finally the authors observed a greater infection rate in polytetrafluoroethylene grafts than in Dacron grafts (p < 0.05). Their results confirm the important role of the axillofemoral bypass in revascularizing high-risk patients with severe limb ischemia (rest pain and necrosis) or patients with graft infection, repeated graft failures, and arterial occlusive disease when laparotomy is contraindicated.