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[Value of axillofemoral bypass in the elderly]
R Hassen Khodja1, S Declemy, M Batt
1Service de chirurgie vasculaire, Hôpital Annexe République, Nice.
Insights
Axillofemoral bypass is a suitable surgical option for elderly patients needing limb salvage due to aortoiliac disease. This procedure offers a viable alternative when direct aortic surgery is not recommended.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Surgical Outcomes
Context:
- Elderly patients often present with complex vascular conditions, including aortoiliac obliterating lesions.
- Direct aortic surgical approaches may carry increased risks in the elderly population.
- Axillofemoral bypass offers an alternative revascularization strategy for limb salvage in this demographic.
Purpose:
- To evaluate the effectiveness and outcomes of axillofemoral bypass surgery in patients over 70 years old.
- To assess the long-term patency rates and survival associated with axillofemoral bypass in elderly individuals.
- To determine the suitability of axillofemoral bypass for limb salvage when direct aortic access is contraindicated.
Summary:
- This retrospective study analyzed 69 axillofemoral bypass grafts in 56 patients older than 70, performed for limb salvage due to aortoiliac lesions.
- Operative mortality was 17%, with 3 major amputations in the first postoperative month. Cumulative survival at 60 months was 18%, with primary and secondary patency rates of 46% and 71%, respectively.
- The findings suggest axillofemoral bypass is well-adapted for elderly patients unsuitable for direct aortic surgery.
Impact:
- Axillofemoral bypass provides a critical limb salvage option for high-risk elderly patients with aortoiliac disease.
- The study contributes data on the long-term efficacy and risks of this procedure in a geriatric population.
- Results support the consideration of axillofemoral bypass in elderly patients where conventional aortic surgery is contraindicated.
Abstract:
The aim of this retrospective study was to assess the merits of axillofemoral bypass in elderly patients. 69 axillofemoral grafts were laid from 1981 to 1985 in 56 patients, all older than 70. They always were aimed at limb salvage due to aortoiliac obliterating lesions (the indications of sepsis of aorto-bifemoral prostheses have been excluded). 13 patients have had an axillo-bifemoral graft and 43 an unilateral axillofemoral graft. The lower anastomosis involved the common femoral artery in 30 cases, the deep femoral artery in 39. The patients were followed up for 1 to 74 months, with an average of 24 months. The operative mortality was of 10 cases (17%). During the first postoperative month, 3 major amputations were required. The cumulated survival rate at 60 months was of 18%, with the primary and secondary patency rates at 60 months being of 46% and 71%, respectively. We conclude that axillofemoral bypass is perfectly adapted to this population of elderly subjects, in whom a direct aortic approach is counterindicated.