[High recurrence rate following axillofemoral bypass: is continued use still justified?]

124 axillofemoral bypass grafts were performed in 105 high risk patients with chronic aortoiliac occlusive disease (1970-1983). Graft thrombosis occurred in 49.35% of 77 unilateral grafts, mostly as early occlusion, whereas in cases of 20 axillobifemoral bypass procedures the incidence of graft thrombosis was 35.0%. By graft thrombectomy, if necessary combined with reconstruction of the femoropopliteal artery segment, and graft exchange the patency rates could be improved in both groups. After 5 years of patency rate was 52.57% in the unilateral and 81.48% in the bifemoral group. In both groups the patency times of every second graft could be prolonged respectively for 16 and 18.8 months. On the whole considering the bifemoral procedure was superior to the unilateral. Considering the high rate of graft thrombosis and the poor long term results, esp. in cases of unilateral grafts, the initial euphoria of using the axillofemoral bypass was not justified. Therefore nowadays the indication for axillofemoral bypass is handled more strictly: high risk patient without any other possibilities to avoid amputation.