Extra-anatomic bypass operation for aorto-iliac disease in poor risk cardio-pulmonary patients

Three years experience with subcutaneous axillo-femoral and bifemoral bypass surgical procedures has been outlined in patients with poor cardio-pulmonary and other risk related factors. Special emphasis has been made regarding technical consideration; advantages and disadvantages have been discussed. There were 49 limbs at risk in this group of 27 patients requiring axillo-bifemoral in 22, and axillo-unifemoral in 5. Sixty-three percent of patients had associated arteriosclerotic heart disease and 48% had severe emphysema. There were 3 peri-operative deaths for 11% hospital mortality and 3 late deaths (12.5%). Six of the remaining patients for whom long term follow-up is available, acute graft thrombosis occurred in 3 patients salvaged by graft thrombectomy and 4 patients had late thrombosis resulting in 3 permanent graft failures. Two patients required above the knee amputation. Limb salvage and relief of lower extremity ischemic pains has been gratifying. During the limited follow-up period from 1-36 months (Mean 18) there is 87% patency rate for 43 grafts to 43 limbs.