Extra-anatomic bypass: a closer view

The results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. Considered in this order, the operative mortality rate was zero, 11%, and 13%, respectively; initial hemodynamic failure was 7%, 13%, and 9%, respectively; 5-year overall primary patency rate was 67%, 62%, and 19%, respectively; and the secondary patency rate was 74%, 82%, and 37%, respectively. However, axillobifemoral patency was made to seem better by including six cases (12 graft limbs) performed because of nonocclusive disease (aneurysm or failure of graft performed for aneurysm). Excluding these, axillobifemoral primary and secondary patency decreased to 47% and 69%, respectively. Femorofemoral bypass results were made worse by cases performed because of unilateral failure of an aortic bifurcation graft. Exclusion of these bypasses increased primary and secondary patency rates to 74% and 82%, respectively. Occlusion of the major outflow artery (superficial femoral) markedly affected long-term patency of all three bypasses. Thus, "good" and "poor" runoff primary patencies were, respectively, for femorofemoral bypass 79% and 53%, for axillobifemoral bypass 92% and 41%, respectively (occlusive disease only), and for axillounifemoral bypass 54% and zero, respectively. This detailed breakdown of results explains the wide variances in the reported results for these extra-anatomic bypasses and provides a better perspective for their application in different clinical settings.