Are axillofemoral bypass grafts worthwhile? A 10-year review

Axillofemoral grafts (144 prostheses: 103 unilateral, 25 bifemoral = y-shaped, and 8 bilateral) were performed in a total of 136 patients with aortoiliac occlusion. The average patient was 69 years old. Surgery was indicated only in "high-risk patients" in either stage II (n = 7; walking distance until onset of pain less than 50 m), stage III (n = 55), or stage IV (n = 74). Early occlusion of the prosthesis occurred in 26 cases; 15 were treated successfully by remedial surgery. The total rate of infection after first and remedial operations was 9.7%. The amputation rate, both early and late, was 19%. The early results showed that 114 patients had reached stage II (walking distance until onset of pain over 100 m). The postoperative follow-up period of up to 116 months (average 27.6 months) revealed that the implanted prosthesis had remained patent in 80% of each group of patients at different postoperative intervals. This is extraordinary considering their length and course. Four fifths of the patients lived an average of 22 months, remaining in stage II without loss of limb(s); we believe it made their life more worth living. We conclude that axillofemoral grafts yield satisfactory results for a selective group, namely the "high-risk patient" with aortoiliac occlusion.