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Results of axillofemoral by-passes for aorto-iliac occlusive disease
G Illuminati1, F G Calio, N Mangialardi
1Fourth Department of Surgery, University of Rome, Italy.
Insights
Axillofemoral bypass surgery for aorto-iliac occlusive disease shows lower patency rates in acute ischemia patients. Patient selection significantly impacts outcomes, suggesting this bypass is best for high-risk individuals.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Peripheral Artery Disease
Background:
- Aorto-iliac occlusive disease significantly impacts lower limb perfusion.
- Axillofemoral bypass is a surgical option for complex cases.
- Outcomes vary based on patient selection and bypass configuration.
Purpose of the Study:
- To review outcomes of axillofemoral bypass for aorto-iliac occlusive disease.
- To assess the influence of patient clinical status on bypass success.
- To compare different axillofemoral bypass configurations.
Main Methods:
- Retrospective review of 51 axillofemoral bypasses in 50 patients (1989-1994).
- Analysis of 30-day mortality, graft complications, and reoperations.
- Evaluation of long-term patency, limb salvage, and survival rates.
- Comparison of outcomes based on indication (acute ischemia vs. claudication/rest pain) and bypass type (axillobifemoral vs. axillo-unifemoral).
Main Results:
- 30-day mortality was 4%; 14% experienced graft complications requiring reoperation.
- At 36 months, primary patency was 51%, secondary patency 69%, and limb salvage 87%.
- Axillobifemoral bypass showed significantly better secondary patency (87%) than axillo-unifemoral (56%) (P < 0.01).
- Patients with acute ischemia had worse outcomes: higher mortality (10%), amputation (20%), and lower patency (26%) compared to claudication patients (P < 0.01).
Conclusions:
- Axillofemoral bypass outcomes are strongly influenced by patient selection, particularly the severity of ischemic symptoms.
- Axillofemoral bypass patency and limb salvage rates are inferior to aortofemoral bypass.
- This procedure should be reserved for high-risk patients unsuitable for aortic clamping procedures.
Abstract:
The purpose of this study was to review our results with axillofemoral by-passes performed for aorto-iliac occlusive disease. Fifty patients receiving 51 axillofemoral by-passes from January 1989 to December 1994 were retrospectively reviewed. The 30-day post-operative mortality was 4%. Seven patients (14%) presented graft-related local complications and all but one required reoperation. Five patients were lost to follow-up, the mean length of which was 36 months (16-74 months). Forty-nine per cent of the patients died during the follow-up period. At 36 months, the primary patency rate was 51%, the secondary patency rate was 69%, and limb valvage rate was 87%. A statistical difference was seen in the secondary patency rate between axillobifemoral by-pass (87%) and axillo-unifemoral by-pass (56%) at 36 months (P < 0.01), but no difference was seen in the limb salvage rate at 36 months between the two configurations of the by-pass (94% vs 81%) (P = NS). Twenty patients (40%) operated upon for acute ischemia had a significantly higher post-operative mortality rate (10% vs 0), a significantly higher amputation rate (20% vs 6.6%) and a significantly lower patency rate of by-pass (26% vs 63%) (P < 0.01), than the 30 patients (60%) operated on for claudication, rest pain or trophic ulcers. Our findings indicate that the results of axillofemoral by-pass are significantly influenced by the selection of patients for operation, namely the clinical status of ischaemic symptoms, and that since the overall results of axillofemoral by-pass are inferior to those of aortofemoral by-pass, this treatment should be restricted to patients at high risk of aortic clamping.