A review of 155 extra-anatomic bypass grafts

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Arterial Disease Management

Background:

• Extra-anatomic bypass grafting is a critical intervention for patients with aorto-iliac disease deemed inoperable for standard aortic surgery.
• A significant majority of patients presented with severe ischemic symptoms, including rest pain or skin necrosis, indicating advanced disease progression.

Purpose of the Study:

• To evaluate the long-term efficacy and outcomes of extra-anatomic bypass grafts in high-risk patients with aorto-iliac occlusive disease.
• To assess graft patency, patient survival, and limb salvage rates associated with femorofemoral (FF) and axillofemoral (AF) bypass procedures.

Main Methods:

• A retrospective analysis of patients undergoing extra-anatomic bypass procedures, including femorofemoral (FF), axillounifemoral (AF), and axillobifemoral (AF) grafts.
• Graft patency, patient survival, and limb salvage rates were tracked over three and five-year periods.
• Complication rates, such as graft declotting, were also recorded.

Main Results:

• Three-year cumulative graft patency was 69% for FF grafts and 48% for AF grafts, decreasing to 61% and 32% respectively at five years.
• Long-term patient survival was notably poor, especially for AF grafts (27% at five years), reflecting the patients' comorbidities.
• Despite survival challenges, limb salvage rates were encouraging: 69% for FF and 72% for AF at three years, and 61% for FF and 65% for AF at five years.

Conclusions:

• Extra-anatomic bypass grafting, particularly FF grafts, provides valuable limb salvage in high-risk patients with aorto-iliac disease who cannot undergo conventional surgery.
• While long-term survival remains a concern due to patient comorbidities, these bypass procedures are effective in preventing amputation.
• Axillofemoral grafts, despite lower patency and survival rates, also contribute to limb salvage, underscoring their role in limb preservation strategies.