Related Experiment Videos
Present role of extraanatomic bypass graft procedures for aortoiliac occlusive disease
1Chirurgische Klinik und Poliklinik, Universitätsklinikum Rudolf Virchow, Standort Charlottenburg, Freie Universität, Berlin, Germany.
Insights
Transverse femorofemoral bypass grafts show excellent long-term patency and low mortality, making them ideal for unilateral iliac artery occlusion. Axillofemoral bypass grafts are now rarely used due to lower patency and higher occlusion rates.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Graft Patency
Background:
- Extra-anatomic bypass grafts, including axillofemoral and femorofemoral bypasses, have been used for high-risk patients.
- Evaluating long-term results is crucial for understanding the current role of these procedures.
Purpose of the Study:
- To evaluate the long-term results and present role of axillofemoral and transverse femorofemoral bypass grafts.
- To compare the outcomes of different extra-anatomic bypass techniques in high-risk patients.
Main Methods:
- Retrospective follow-up study of 173 extra-anatomic bypass operations (131 axillofemoral, 42 femorofemoral) in 150 high-risk patients between 1970 and 1989.
- Analysis of operative mortality, graft patency rates at 5 and 10 years, and late mortality.
Main Results:
- Femorofemoral bypass had lower elective operative mortality (2.4%) than axillofemoral bypass (5.3%).
- Five-year cumulative patency rates were 86.82% for femorofemoral, 73.74% for axillo-bifemoral, and 43.18% for unilateral axillofemoral bypass.
- Femorofemoral bypass patency remained stable at 10 years, while axillofemoral bypasses experienced significant occlusion rates.
Conclusions:
- Transverse femorofemoral bypass is a preferred surgical option for unilateral iliac artery occlusion due to its excellent long-term results and low operative mortality.
- Axillofemoral bypass has been largely replaced by anatomical procedures for bilateral occlusive disease in high-risk patients, with current indications limited to specific infection scenarios.
Abstract:
In a retrospective follow-up the long-term results and present role of axillofemoral and transverse femorofemoral bypass grafts are evaluated. During the period from 1970 until 1989 173 extraanatomic bypass operations were carried out on 150 high risk patients. There were 131 axillofemoral and 42 femorofemoral bypass grafts. In elective operations the mortality ranged from 5.3% for the axillofemoral bypass and 2.4% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate of 86.82% for the femorofemoral bypass, 73.74% for the axillo-bifemoral bypass and 43.18% for the unilateral modification. After ten years the results of femorofemoral bypass remained unchanged. In contrast nearly every second axillofemoral bypass showed one to five graft occlusions. Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure on the one hand femorofemoral bypass has presented more and more as surgical method of choice in cases of unilateral iliac artery occlusion and unilateral branch occlusion of aortoiliac bifurcation grafts as well. On the other hand in cases of bilateral occlusive disease in high risk patients axillofemoral bypass has been displaced more and more by anatomical surgical procedures as endarterectomy or unilateral bypass using retroperitoneal approach. Since 1986 axillofemoral bypass has no longer been performed in elective cases. Nowadays an indication does exist only for deep wound infection in retroperitoneal or inguinal space.