Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts

Abstract

The axillary-femoral bypass graft is an alternative to direct anatomic procedures for patients with aortoiliac occlusive disease. Touted for its low morbidity and mortality rates, with corresponding improved patency rates, this extra-anatomic procedure has been considered safe and effective. Noncompromising upper extremity ischemia and one case of upper extremity loss, associated with early graft thrombosis, have been reported previously. This article describes two eases of late axillary artery thrombosis, occurring 4 and 6 months after graft thrombosis, which severely jeopardized the viability of the ipsilateral upper extremity. Experience with these patients has shown that a thrombosed axillary-femoral bypass graft may jeopardize the viability of the ipsilateral upper extremity many months after its failure. The absence of information in the literature regarding this complication suggests this is a rare complication of thrombosed axiUary-femoral grafts.

Endovascular management of axillofemoral bypass graft stump syndrome

“…7 However, others have suggested that the configuration of graftaxillary artery anastomosis and its transformation into a Y configuration as a result of undue tension has been hypothesized to contribute to distal embolization after graft thrombosis. 10,11 In neither of our patients was Y configuration of the anastamosis observed. Furthermore, management of these thrombosed grafts has been debated.…”

Surgical Repair of Axillary Graft Stump Syndrome: Report of Two Cases

“…5) Furthermore, others have suggested that the lumen narrowing with irregurality of the wall either occurring as part of an intimal hyperplastic response or a confi guration of graft-axillary artery anastomosis and its formation into a "Y" confi guration as a result of undue tension contributes to distal embolization after graft thrombosis. [6][7][8] In the present cases, thrombotic material from the occluded graft was observed in case 2 and a "Y" confi guration of the anastomosis which led to the occlusion of axillary artery and thromboembolism of brachial artery was observed in case 1. We think it important to adjust the graft to the proper length to prevent undue tension at the initial surgery.…”