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Axillopopliteal bypass for limb salvage.
M P Keller1, J R Hoch, A D Harding
1Department of Surgery, University of Missouri-Columbia 65212.
Journal of Vascular Surgery
|May 1, 1992
Summary
Axillopopliteal bypass grafts offer limb salvage for patients unsuitable for standard procedures. Externally supported polytetrafluoroethylene (PTFE) grafts and sequential vein grafts improve long-term patency.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
Background:
- Limb salvage is critical for patients with peripheral artery disease.
- Axillopopliteal bypass is an option when standard revascularization is not feasible.
Purpose of the Study:
- To evaluate the efficacy and outcomes of axillopopliteal bypass grafts for limb salvage.
- To compare the patency rates of different graft materials and configurations.
Main Methods:
- Retrospective analysis of 41 axillopopliteal bypass grafts in 30 patients over 12 years.
- Life-table analysis of primary and secondary patency, limb salvage, and patient survival.
- Comparison of ringed versus unsupported polytetrafluoroethylene (PTFE) grafts and sequential grafts.
Main Results:
- 3-year primary patency was 43%, secondary patency 50%, and limb salvage 69%.
- Ringed PTFE grafts showed higher 3-year patency (61%) than unsupported PTFE (40%).
- Sequential grafts with ringed PTFE and saphenous vein achieved 67% 3-year patency. Thrombectomy with revision restored patency in 80% of occluded grafts.
Conclusions:
- Axillopopliteal bypass is a viable limb salvage option for select patients.
- Externally supported PTFE and sequential vein grafts enhance long-term graft patency.
- Graft revision improves outcomes for occluded bypasses.