Axillofemoral bypass: A tool with a limited role

Abstract

Axillofemoral bypass (AXB) was performed on 100 patients who had claudication (19), pain at rest (42), gangrene or ulcer (22), aortic sepsis (14), or unresectable abdominal aneurysm (3). Unilateral (27 grafts), double unilateral (1), or axillobifemoral (72) grafts with Dacron (58), polytetrafluoroethylene (PTFE) (28), ring-supported Dacron or PTFE (12), or other material (2) were performed by 13 surgeons. Eight patients died within 30 days and three major amputations were necessary. Fifty-two (57%) of the 92 survivors had a total of 92 graft complications during a mean follow-up period of 21.5 months. Thirty-two patients underwent 57 reoperations of various types, incurring an additional three deaths and three amputations. Sixty (65%) of the original 92 survivors of AXB avoided reoperation. The 89 patients who survived the original and repeat procedures were followed up through the end of 1984 (62 patients), to late death (23), or to late graft removal (4), whichever occurred first. At these end points, 83 of the 89 (93%) patients had patent grafts. The graft patency rate of the original 100 AXBs by life table was 54% at 36 months; but with reoperation, it was 72%. Among those patients who left the hospital after AXB, the survival rate at 36 months was 69%. Statistically insignificant trends toward improved early patency were noted with bilateral femoral anastomoses, total iliac occlusion, and less severe ischemia. AXB provided safe palliation of severe arterial disease, with overall graft patency exceeding postoperative patient survival according to life-table analysis. However, the safety of AXB was tempered by frequent complications and the necessity for many reoperations to provide maximum efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

Axillobifemoral Bypass: A Brief Surgical and Historical Review

“…Burrell et al (1982) compared the effectiveness of Dacron® versus polytetrafluoroethylene (PTFE) on graft patency, and found no significant difference in patency rates. These conclusions were replicated and confirmed by Donaldson et al, in 1986.…”

“…Complications of AXFBG include graft thrombosis or infection (Passman et al, 1996; Ray et al, 1979; Burrell et al, 1982; Donaldson et al, 1986), seroma (Donaldson et al, 1986), plexus lesions (Kempczinski and Penn, 1978), and arterial steal syndrome (Kempczinski and Penn, 1978). Patients may need to undergo a thrombectomy or total graft replacement in order to maintain patency.…”

“…al., 1986). In some cases, if the graft cannot be fixed, patients will undergo amputation (Donaldson et al, 1986). Due to the possibility of developing these severe complications, some have called into question the usefulness of AXFBG (Donaldson et al, 1986).…”

“…In some cases, if the graft cannot be fixed, patients will undergo amputation (Donaldson et al, 1986). Due to the possibility of developing these severe complications, some have called into question the usefulness of AXFBG (Donaldson et al, 1986). Despite the complication rate, the five-year primary graft patency rate has been reported in the range of 54% (Martin and Katz, 2000) to 80.4% (Passman et al, 1996; Ray et al, 1979).…”

“…In patients that undergo thrombectomy, as many as 97% can expect no further complications over the following five-year period (Burrell et al, 1982). Post-operative care for AXFBG patients may include the use of anti-thrombotic agents, particularly in patients who require multiple reoperations to maintain graft patency (Donaldson et al, 1986). Some evidence has shown that anti-platelet medications such as aspirin can be beneficial for patients with synthetic grafts (Slovut and Lipsitz, 2012; Dorffler-Melly et al, 2003).…”