[Axillo-femoral bypass. Long-term results]
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Published on: March 27, 2018
P Bergeron1, N Mangialardi, P Sarradon
1Service de Chirurgie Cardio-Vasculaire, Hôpital Saint-Joseph, Marseille.
Insights
Axillo-femoral bypass surgery offers a reliable solution for patients with severe peripheral artery disease and high surgical risk. This procedure demonstrates good long-term patency and limb salvage rates, particularly for frail individuals.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Context:
- Axillo-femoral bypass is an extra-anatomical revascularization technique.
- This study evaluates outcomes in 182 patients with Leriche stages II-IV disease.
- Patients had high surgical risk due to comorbidities like cardiac and respiratory disease.
Purpose:
- To assess the long-term efficacy and safety of axillo-femoral bypass.
- To analyze patency rates, limb conservation, and survival.
- To determine the suitability of this procedure for high-risk patients.
Summary:
- The study followed 182 patients (mean age 68) undergoing axillo-femoral bypass between 1974-1981.
- Low mortality (2.7%) and acceptable early complication rates (15%) were observed.
- Long-term analysis showed 5-year patency of 86.4%, 5-year limb conservation of 91.1%, and 5-year survival of 46.7%.
Impact:
- Axillo-femoral bypass is a simple, reliable method for extra-anatomical revascularization.
- It provides good long-term results, especially for patients in poor general health.
- The procedure contributes to limb salvage and improved quality of life in high-risk populations.
Abstract:
182 patients underwent axillo-femoral bypass between April 1974 and December 1981 (29 women and 153 men). Mean survival was 43 months. The mean age was 68 years (range: 40-90). 10.9% of patients were Leriche stage II, stages III and IV accounted for 69.7% of cases. All presented a high surgical risk with cardiac disease present in 43.4% and severe respiratory failure in 36.8%. Depending on the year studied, this procedure represented 10 to 15% of the aorto-iliac revascularisations carried out. Mortality was low (5 cases = 2.7%). Early complications (15%) included 11 cases (6%) of early thrombosis requiring reintervention, and late complications included 48 cardiac problems (26.3%). Analysis of the results in the long term was carried out according to an actuarial method over a period of 10 years. The secondary permeability rate was 86.4% at 5 years and 68.8% at 10 years with a 30% secondary thrombectomy rate (25% long term). Limb conservation at 5 and 10 years was respectively 91.1% and 82.7% while for the same periods survival was 46.7% and 19.7%, confirming the grave condition of the patients. We can conclude that axillo-femoral bypass remains a simple and reliable method with good long term results. When extra-anatomical revascularisation seems indicated, it is particularly suitable for subjects in very poor general health.
