Axillofemoral bypass: a tool with a limited role

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Graft Patency

Background:

• Axillofemoral bypass (AXB) is a critical intervention for severe peripheral arterial disease.
• Indications for AXB include claudication, critical limb ischemia, aortic sepsis, and unresectable abdominal aneurysms.

Purpose of the Study:

• To evaluate the outcomes of axillofemoral bypass (AXB) surgery.
• To assess graft complications, reoperation rates, and long-term patency and survival following AXB.

Main Methods:

• Retrospective analysis of 100 patients undergoing AXB procedures.
• Grafts included unilateral, double unilateral, and axillobifemoral configurations using Dacron or PTFE materials.
• Follow-up included assessment of graft complications, reoperations, patency, and patient survival.

Main Results:

• Early mortality was 8% with three major amputations. Of 92 survivors, 57% experienced 92 graft complications within 21.5 months.
• Thirty-two patients required 57 reoperations, leading to three additional deaths and amputations. 65% of survivors avoided reoperation.
• Long-term graft patency was 54% at 36 months, increasing to 72% with reoperation. Patient survival at 36 months was 69%.

Conclusions:

• Axillofemoral bypass (AXB) provides safe palliation for severe arterial disease, with overall graft patency exceeding patient survival.
• Despite frequent complications and necessary reoperations, AXB demonstrates acceptable long-term efficacy.
• Reoperation significantly enhances graft patency, underscoring its importance in managing AXB complications.