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Axillofemoral bypass for aortoiliac occlusive disease
1Department of Surgery, Huntington Memorial Hospital, Pasadena, Division of Vascular Surgery, University of Southern California School of Medicine, Pasadena, California, USA.
Insights
Axillofemoral bypass is a reproducible and effective treatment for chronic aortoiliac occlusive disease, offering long-term patency comparable to other methods. It is a suitable option for high-risk patients needing lower extremity revascularization.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Surgical Outcomes
Background:
- Aortoiliac disease frequently causes lower extremity ischemia, but axillofemoral bypass efficacy is debated.
- This study evaluates institutional experience with axillofemoral bypass for chronic aortoiliac occlusive disease.
Purpose of the Study:
- To assess the long-term efficacy and outcomes of axillofemoral bypass grafting.
- To compare axillofemoral bypass results with other revascularization techniques for aortoiliac disease.
Main Methods:
- Retrospective review of 60 consecutive axillofemoral bypass grafts (1984-1997).
- Inclusion criteria: chronic aortoiliac occlusive disease; focus on patient demographics, risk factors, and outcomes.
- Kaplan-Meier method used for primary patency analysis; log rank test for group comparisons.
Main Results:
- Primary patency rates at 1, 3, and 5 years were 86%, 72%, and 63%, respectively.
- Thirty-day mortality was 4.9%; 60% of graft occlusions occurred in the femorofemoral limb.
- No significant impact of risk factors, procedure type, or superficial femoral artery patency on long-term outcomes.
Conclusions:
- Axillofemoral bypass demonstrates reproducible, long-term patency rates comparable to aortobifemoral bypass and superior to angioplasty for chronic aortoiliac disease.
- This procedure is an excellent alternative for patients with prohibitive risks for direct aortic reconstruction or limited life expectancy.
Background:
Although aortoiliac disease remains a common cause of lower extremity ischemia, the efficacy of axillofemoral bypass in this setting remains controversial. This report summarizes our institutional experience with axillofemoral bypass.
Methods:
A retrospective review of consecutive axillofemoral bypass grafts was performed at a single institution between 1984 and 1997. Only patients presenting with chronic aortoiliac occlusive disease were included. Patient demographics, risk factors, indications for surgery and outcomes were recorded. Survival curves for primary patency were plotted using the Kaplan-Meier method according to the standards set by the Society of Vascular Surgery-International Society for Cardiovascular Surgery. Comparisons between groups were made using the log rank method. Statistical significance was assumed at P values <0.05.
Results:
Sixty patients underwent axillofemoral bypass grafting of which 53 were bifemoral and 8 unifemoral. Forty-seven procedures were performed for limb salvage. Primary patency rates at 1, 3, and 5 years were 86%, 72%, and 63%, respectively. Thirty-day mortality rate was 4.9%. Sixty percent of graft occlusions occurred in the femorofemoral limb with continued patency of the axillofemoral limb. Risk factors, type of procedure and superficial femoral artery patency had no statistically significant effect on long-term patency.
Conclusions:
In the setting of diffuse, chronic aortoiliac occlusive disease, long-term patency rates of axillofemoral grafts approach those of aortobifemoral bypass and exceed those quoted for percutaneous transluminal angioplasty, with results that are highly reproducible. Axillofemoral bypass is an excellent option in those patients at prohibitive risk for direct aortic reconstruction or those with limited life expectancy.