Axillobifemoral Bypass: A Brief Surgical and Historical Review

Abstract

Peripheral artery disease (PAD) occurs when plaque accumulates in the arterial system and obstructs blood flow. Narrowing of the abdominal aorta and the common iliac arteries due to atherosclerotic plaques restricts blood supply to the lower limbs. Clinically, the lower limb symptoms of PAD are intermittent claudication, discoloration of the toes, and skin ulcers, all due to arterial insufficiency. Surgical revascularization is the primary mode of treatment for patients with severe limb ischemia. The objective of the surgical procedure is to bypass a blockage in an occluded major vessel by constructing an alternate route for blood flow using an artificial graft. This article presents information on aortoiliac reconstruction, with an emphasis on axillobifemoral bypass grafting.

Combined Coronary Artery Bypass Grafting and Extra-anatomic Ascending Aorta to Bifemoral Grafting Through Median Sternotomy

“…Patients often present with severe systemic atherosclerotic disease with the involvement of the coronary and aortoiliac arteries [8,9]. With symptomatic occlusion of these systems, extraanatomic bypass grafting for aortoiliac disease is an indicated and reliable surgical option [10][11][12][13]. In these select patients, the goals of preoperative planning should aim to combine interventions into one operation, avoid opening the abdominal cavity, and improve peri-and postoperative graft patency.…”

“…It is also essential to minimize the overall physiologic burden of the operation, given the already high risk level of such cardiovascular surgeries and patient population. Opening the abdominal cavity and cross-clamping the aorta can be avoided with a proximal anastomosis outside of the abdomen and tunneling down to the lower extremities subcutaneously for the distal anastomosis [11]. This extra-anatomic bypass grafting technique minimized the technical complexity and total operation time.…”

Single-Center Experience on Extra-Anatomic Arterial Revascularisation Applications

“…Blaisdel and Hall proposed the axillofemoral (AF) bypass in 1962; Sauvage and Wood performed the axillofemoral bypass (AFF) surgery in 1966. Shaw and Baue performed the obturator bypass (OB) surgery in patients with localized graft infection in inguinal region for the first time [2][3][4]. Many patients for whom amputation may have to apply to in the past can now be successfully treated with the development of surgical methods, repair techniques (repair techniques for what?)…”

“…Many patients for whom amputation may have to apply to in the past can now be successfully treated with the development of surgical methods, repair techniques (repair techniques for what?) and materials, as well as the use of endovascular interventions, one of the surgical treatment techniques of peripheral arterial disease [4,5].…”

“…Currently, although endovascular applications are used more widely with developing technology and experience gained, in particular, except for upper and lower extremity revascularization in selected patient groups, extra-anatomic bypass grafting can be applied to the thoracic aorta, carotid, vertebral and renal arteries [5,6]. Extra-anatomic bypass grafting is preferred when general anesthesia and/or surgery are considered to be high-risk such as critical limb ischemia, severe coronary artery disease, coronary disease, chronic obstructive pulmonary disease, arterial hypertension, cerebrovascular insufficiency, diabetes, and renal failure [2][3][4][5]. Besides, EAB is applied to facilitate the surgical technique in case of an inability to pass the graft through the anatomical region due to infection, tumor invasion, previous operation or radiotherapy, and in case of postural degeneration and inability to position the patient or extremity [5][6][7].…”