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Upper extremity thromboembolism caused by occlusion of axillofemoral grafts
R B McLafferty1, L M Taylor, G L Moneta
1Department of Surgery, Oregon Health Sciences University, Portland, USA.
Insights
Occlusion of axillofemoral bypass grafts (AxFG) can lead to upper extremity thromboembolism. Prophylactic detachment of the axillary portion of the graft may prevent this complication in certain patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Complications
Background:
- Axillofemoral bypass graft (AxFG) is a treatment for lower extremity ischemia in high-risk patients with aortoiliac occlusive disease.
- The incidence and management of upper extremity (UE) thromboembolism from AxFG occlusion are not well-defined.
Purpose of the Study:
- To report the incidence of UE thromboembolism resulting from AxFG occlusion.
- To evaluate the outcomes of treatment for AxFG occlusion and associated UE thromboembolism.
Main Methods:
- A retrospective review of 202 AxFGs in 182 patients performed between 1984 and the present.
- Standardized technique using externally supported 8-mm polytetrafluoroethylene grafts.
- Identification of UE thromboembolism through patient record review.
Main Results:
- AxFG occlusion occurred in 20 patients (9.9%).
- Fifteen patients (75%) underwent immediate graft revision.
- Six UE thromboembolic complications occurred in 5 patients (2.5% of all patients, 25% of occluded grafts). Four of these occurred in patients with unrepaired occluded grafts.
Conclusions:
- Upper extremity thromboembolism is a significant complication of occluded AxFGs.
- Prophylactic detachment of the axillary artery may be prudent in patients not requiring immediate AxFG revision.
Background:
The axillofemoral bypass graft (AxFG) is increasingly accepted as treatment for lower extremity ischemia caused by aortoiliac occlusive disease in high-risk patients. The incidence of upper extremity (UE) thromboembolism caused by occlusion of an AxFG and the results of treatment form the basis for this report.
Methods:
From 1984 to the present, all patients undergoing axillofemoral bypass grafting were followed up in a vascular registry. A standardized operative technique, using an externally supported 8-mm polytetrafluoroethylene graft, was used in performing 202 AxFGs in 182 patients. UE thromboembolism caused by occlusion of an AxFG was identified by retrospective patient record review.
Results:
Occlusion of an AxFG occurred in 20 patients. Fifteen patients (75%) underwent immediate revision of the occluded graft. Two patients (10%) developed UE thromboembolism simultaneous with graft occlusion. One of these patients had immediate revision of the graft, and 1 had brachial embolectomy only. This patient and 4 others (25%) had the occluded AxFG left in place. Four of these 5 patients (80%) developed UE thromboembolism at 26 days, 2 years, 5 years, and 7 years, respectively, after occlusion. Overall, six UE thromboembolic complications occurred in 5 patients.
Conclusions:
UE thromboembolism represents a significant and specific complication of occluded AxFGs in our series (2.7% of patients, 25% of occluded grafts). It may be prudent to prophylactically detach the axillary portion of the graft and repair the axillary artery in patients who do not require immediate revision of an occluded AxFG.