New concepts in the use of axillofemoral bypass grafts

Over a four-year period, 52 patients underwent axillofemoral bypass operations. Indications for operation were divided into three groups: those that were performed emergently (aortoenteric fistula, graft infection, and leaking aortic aneurysm), those performed electively for aneurysm, and those for ischemia. Operative procedures were categorized as follows: axillofemoral bypass alone, axillofemorofemoral bypass with the proximal femorofemoral anastomosis being graft to graft, or axillofemorofemoral bypass with the femorofemoral anastomosis to either a transected proximal common femoral artery or superficial femoral artery distal to the axillofemoral anastomosis. Thirty-three percent of the unilateral axillofemoral grafts failed, while only 14% of the axillobifemoral grafts failed. There was a further difference between the two methods of femorofemoral grafting with 22% failure in the former group but no failures in the latter.