Axillofemoral and femorofemoral grafts: A 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival

Abstract

Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of less than 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.

Smoking and the patency of lower extremity bypass grafts: A meta-analysis

“…Of these 29 had to be excluded. 6,11,12,[17][18][19]21,22,26,27,29,[31][32][33][34][35][36][37][38]41,43,44,50,52,53,[57][58][59][60] Reasons for this were the absence of separate data on smokers and nonsmokers (n ϭ 16), only on critical ischemia (n ϭ 1), only on reoperations after graft failure (n ϭ 3), or the data on angioplasty and grafts had not been separated (n ϭ 3). Three articles, written in Polish, Serb, and Russian, were not included because they could not be retrieved.…”

Endovascular treatment of an occluded axillofemoral bypass graft

“…In one series, early graft failure correlated with reduced basal and maximal flow in response to the vasodilator papaverine; late graft failure appeared unrelated to intra-operative blood flow. 17 Duplex ultrasound may play a role in graft surveillance. 18 Musicant and colleagues examined 78 patients with axillobifemoral grafts.…”

The role of extra‐anatomic grafts for lower limb ischaemia

“…When an axillo‐femoral graft is indicated, a bifurcation graft is preferable. This may be because axillo‐bifemoral grafts have a greater run‐off than axillo‐unifemoral grafts and hence have a higher flow in the vertical limb of the graft, making them less likely to thrombose 8 …”