Axillofemoral bypass. Expectations and results

We studied 33 patients who received axillofemorofemoral or axillofemoral polytef (polytetrafluoroethylene [PTFE]) grafts. The follow-up period ranged from six to 60 months. Most patients were operated on for limb salvage. The 30-day operative mortality was 7% for elective or urgent procedures and 67% for emergency procedures. Twelve amputations were performed, but nine were necessitated by preexisting tissue loss and three were performed below rather than above the knee following proximal revascularization. Cumulative graft patency was 91% at three years and 75% at five years. Patient survival was only 54% at three years and 41% at five years. Graft patency exceeded patient survival at every interval. In a select group of high-risk patients requiring proximal revascularization for limb salvage, axillofemorofemoral bypass offers an acceptable alternative to an in situ aortofemoral graft.