[Axillo-femoral bypass using PTFE. Early and secondary results. 104 patients]

Between 1977 and 1981, 104 patients underwent 115 axillo-femoral bypass operations (AFB). All the indications were based upon limb salvage. Ninety-nine unilateral bypasses and only 8 axillo-bi-femoral procedures were performed. Prolongation of revascularisation by femoro-popliteal bypass was necessary in 10 cases, in 1 or 2 stages. Secondary bilateralisation of an unilateral bypass was required in only 6 cases because of the development of gangrene of the other limb. The postoperative mortality was 6% (5 patients) in the gangrene group and was 33% (6 patients) in the acute ischaemia group. Study of the cumulative permeability of bypasses until the time of their first thrombosis showed that 62% were permeable at 1 year and 44% at 4 years. Thrombectomy was followed by a percentage permeability of 10%. Weight bearing was still possible by 75% of limbs after 5 years. In conclusion to this study: axillo-femoral bypass remains reserved for salvage of the limb; extension of implantations to the distal and/or pathological artery remains legitimate; PTFE seems the most suitable material at present; the development of a thrombosis in the first 18 months should be treated by thrombectomy in order to decrease the number of amputations.