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Extra-anatomical bypass grafting--a single surgeon's experience.

N D Appleton1, D Bosanquet, G Morris-Stiff

  • 1Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK.

Annals of the Royal College of Surgeons of England
|June 5, 2010
PubMed
Summary
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Extra-anatomical bypass grafting offers good outcomes for high-risk patients. Femoro-femoral bypass shows comparable limb salvage to axillo-femoral bypass, though axillary procedures have lower survival rates.

Area of Science:

  • Vascular Surgery
  • Reconstructive Surgery

Background:

  • Extra-anatomical bypass grafting is a key re-vascularization technique for high-risk patients with lower limb ischemia.
  • It is indicated for patients unable to tolerate aortic clamping or those with abdominal issues.

Purpose of the Study:

  • To evaluate outcomes of extra-anatomical bypass procedures performed by a single surgeon.
  • To compare femoro-femoral bypass with axillo-femoral bypass in terms of patency, survival, and limb salvage.

Main Methods:

  • Retrospective review of a prospectively maintained database.
  • Analysis of patients undergoing femoro-femoral or axillo-femoral bypass between 1986 and 2004.

Main Results:

  • At 5 years, patency rates were 55% for femoral and 67% for axillary bypass. Survival rates were significantly lower for axillary bypass (38% vs. 73% for femoral). Limb salvage rates were comparable (81% vs. 92%).

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  • Major amputation within 12 months was associated with a high mortality rate.

    • Conclusions:

    • Extra-anatomical bypass surgery can achieve acceptable morbidity, patency, and survival rates in high-risk patients.
    • While axillary bypass has lower survival, its long-term patency is comparable to femoral bypass among survivors.
    • Patients avoiding amputation have a good prognosis for long-term limb salvage.