Thrombosis of axillary-femoral bypass secondary to prosthesis suspension belt

Patients with peripheral vascular disease and lower extremity amputation frequently undergo arterial bypass surgery to salvage the opposite leg. Compression of axillary-femoral bypass grafts can occur from a variety of causes. The primary physician should monitor graft pulses closely. Compression should be avoided by using forearm crutches instead of axillary crutches. Waist belts for prosthetic support should not be used, and alternatives such as a thigh corset or shoulder suspension should be used. The patient should avoid sleeping on the graft, using a wrist restraint when necessary. If the patient gains weight, garments should be adjusted so as not to be constricting. Upper extremity exercises, particularly in should abduction and extension, should not be so vigorous as to put tension on the graft. A 77-year-old woman with a left below-knee amputation underwent an axillary-femoral bypass for right lower extremity arterial insufficiency which subsequently thrombosed due to compression by the waist belt of her below-knee prosthesis. A series of guidelines are outlined, so that the physiatrist can help maintain graft patency, prolong limb salvage, and avert similar complications in such patients.