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Late results following extra-anatomic bypass procedures for chronic aortoiliac occlusive disease
1Department of Surgery, Klinikum Charlottenburg, Free University Berlin, West-Germany.
Insights
Femorofemoral and axillobifemoral bypass grafts are effective for high-risk patients, offering low mortality and good patency. Unilateral axillofemoral grafts had poor long-term results and high thrombosis rates.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
Background:
- Extra-anatomic bypass surgery is a critical revascularization technique for high-risk patients.
- Assessing the long-term efficacy of different extra-anatomic bypass configurations is essential.
Purpose of the Study:
- To evaluate the outcomes of femorofemoral and axillofemoral bypass grafts in high-risk patients.
- To compare the patency rates and mortality associated with different types of extra-anatomic bypasses.
Main Methods:
- Retrospective analysis of 150 extra-anatomic bypass operations (124 axillofemoral, 26 femorofemoral) in 129 high-risk patients from 1970-1983.
- Life table method used for five-year postoperative follow-up to determine cumulative patency rates.
Main Results:
- Low operative mortality: 3.7% for femorofemoral, 4.9% for axillofemoral bypass.
- Five-year cumulative patency: 80.21% (femorofemoral), 79.90% (axillobifemoral Type IV), 45.77% (unilateral axillofemoral Types I & II).
- High graft thrombosis and poor long-term results were observed in unilateral axillofemoral grafts (Types I & III).
Conclusions:
- Femorofemoral and axillobifemoral bypasses are suitable and effective for high-risk patients due to low operative mortality and good late results.
- Unilateral axillofemoral bypasses demonstrate a high rate of graft thrombosis and inferior long-term outcomes.
- High late mortality, independent of surgical procedure, underscores the severity of underlying conditions in this patient cohort.
Abstract:
During the period from 1970 to 1983 150 extra-anatomic bypass operations were carried out on 129 high risk patients revascularizing 157 extremities. There were 124 axillofemoral and 26 femorofemoral bypass grafts. In elective operations the mortality ranged from 4.9% for the axillofemoral bypass and 3.7% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate (according to life table method) of 80.21% for the femorofemoral bypass, 79.90% for the axillobifemoral bypass (Type IV) and 45.77% for the unilateral axillofemoral bypass (Type I and II). Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure, the femorofemoral bypass and in many ways also the axillobifemoral bypass represent suitable and effective methods of operation for high risk patients, whereas unilateral and bilateral axillofemoral grafts showed a high rate of graft thrombosis and poor long term results (Type I and III).