Indications and role of axillofemoral bypass in high-risk patients

The purpose of this study was to determine whether axillofemoral bypass was justified as an alternative revascularization procedure to direct reconstruction and to specifically define the indications for this extraanatomical bypass. Forty-one patients operated on between 1978 and 1985 were evaluated. The average age was 69 years. Indications were based upon limb salvage for aortoiliac occlusive disease in the following situations: infected aortobifemoral bypass graft (8 patients) and high risk with co-existing medical problems (33 patients). Patients were classified according to Goldman's Multifactorial Index of Cardiac Risk and Cooperman's Cardiovascular Risk Index. Twenty-four patients had axillobifemoral bypass and 17 had unilateral axillofemoral procedures. In 66 femoral anastomoses there were 13 extended profundaplasties, 25 profunda arterioplasties, 11 profunda patch angioplasties and 16 anastomoses to the common femoral artery. Postoperative mortality was 4.8% (2 patients). Cumulative survival at 60 months was 43% +/- 11% and primary patency rate of the axillofemoral bypass was 69 +/- 9.8%. We conclude that axillo-femoral bypass is indicated in the presence of infection, in patients who fall into Goldman's Class III-IV or in patients with risk greater than 10% as calculated by Cooperman's equation.