Treatment of aortoiliac disease by axillofemoral artery bypass

Between July 1, 1971 and June 30, 1977, 45 axillofemoral artery bypass procedures were performed on 39 men and 5 women whose average age was 67.7 years. Twenty-four patients received 25 unilateral axillofemoral bypasses; the remaining 20 patients underwent axillobifemoral artery procedures. The indication for surgery in 42 patients was limb salvage; the other 2 had infected aortic prostheses. All patients in the former group had serious associated disorders which would have made a conventional intra-abdominal procedure hazardous. The early mortality was 2.3% and the late mortality 29.6%. Of these 45 grafts 20 became occluded; however, 8 of the occluded grafts were successfully revised and have remained patent. For the 25 unilateral grafts at risk the 5-year cumulative patency rate determined by life-table methods was 50.6% and for the 20 bilateral grafts it was 89.7%. Our experience indicates that axillobifemoral bypass has a significantly (P less than 0.02) higher patency rate than unilateral axillofemoral bypass and is an acceptable alternative to conventional intra-abdominal procedures in elderly and poor-risk patients with aortoiliac disease.