Axillofemoral bypass: compromised bypass for compromised patients

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Graft Patency

Background:

• Axillofemoral bypass (AXF) is typically reserved for patients with contraindications to abdominal aortic surgery.
• Recent studies suggest improved AXF outcomes, prompting a re-evaluation of its indications.

Purpose of the Study:

• To review the experience with AXF to identify factors affecting outcomes.
• To determine if recent AXF results have improved.
• To assess if extended indications for AXF are justified.

Main Methods:

• A retrospective review of 153 axillofemoral bypasses (AXF), including axillobifemoral and axillounifemoral procedures.
• Data collected from October 1974 to December 1992.

Main Results:

• Three-year primary and secondary patency rates were 49.4% and 65.7%, respectively.
• Factors adversely affecting primary patency included superficial femoral artery occlusion and distal anastomosis to the deep femoral artery.
• Operative mortality for claudication was 8.3% (5.9% after 1984); 3- and 5-year survival rates were 55.8% and 39.2%.

Conclusions:

• External support and more recent surgery did not improve AXF patency rates.
• The study's findings do not support extending the indications for axillofemoral bypass grafting.