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[Axillo-femoral bypass: indications and results]
1Chirurgische Klinik, Kantonsspital Luzern.
Insights
Axillofemoral bypass grafting offers significant limb salvage and improved quality of life for patients over sixty with lower limb vascular insufficiency. Advanced age is not a contraindication for this procedure.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Geriatric Medicine
Context:
- Axillofemoral bypass grafting is a critical intervention for lower limb vascular insufficiency.
- It serves high-risk patients unsuitable for aortofemoral bypass.
- Evaluating its efficacy in the "sixty-plus" demographic is essential.
Purpose:
- To assess the risk-benefit ratio of axillofemoral bypass grafting in patients aged 60 and above.
- To determine the long-term outcomes, including survival and limb salvage rates.
- To evaluate the impact on patient quality of life, measured by Fontaine classification.
Summary:
- Twenty-three axillofemoral bypass procedures were performed, primarily using 8 mm Dacron prostheses.
- The 30-day mortality was 8.7%, with a 5-year survival rate of 52.2%.
- One- and 5-year patency rates were 80% and 64%, respectively, with limb salvage at 90% and 72%.
Impact:
- Axillofemoral bypass grafting demonstrates considerable limb salvage and functional improvement in older adults.
- A reduction of 1.3 Fontaine stages after 5 years signifies a substantial enhancement in quality of life.
- The study suggests advanced age should not preclude consideration for this life-improving surgical option.
Abstract:
Axillofemoral bypass grafting is an accepted method for the treatment of vascular insufficiency of the lower limb. It is especially useful in high risk patients whose conditions preclude aortofemoral bypass grafting. The goal of our study is to evaluate whether the benefit of this operation outweigh the potential risks in the age group "sixty-plus". We performed 23 axillofemoral bypass grafting procedures (axillofemoral in 20, axillobifemoral in 3 cases) mainly be mean of 8 mm Dacrom prosthesis. The 30-day operative mortality rate was 8.7% and the cumulative 5-year patient survival rate was 52.2%. Overall the 1- and 5-year life table patency rate were 80% and 64%, respectively. The cumulative limb salvage was 90% and 72% at 1 and 5 years. We obtained an average reduction in Fontaine classification of 2 stages in the first year and 1.3 stages after 5 years. The comparison of the cumulative survival rate with the limb salvage rate indicates that advanced age should not be considered a contraindication to performing an axillofemoral bypass graft. The reduction in Fontaine stage means a remarkable improvement in quality of life.