COMPARISON OF AXILLOFEMORAL AND AORTOFEMORAL BYPASS FOR AORTOILIAC OCCLUSIVE DISEASE

Purpose: A comparison of aortofemoral bypass grafting (AOFBG) and axil lofemoral bypass grafting (AXFBG) for occlusive disease performed by t he same surgeons during a defined interval forms the basis for this re port. Methods: Data regarding all patients who underwent AOFBG or AXFB G for lower-extremity ischemia caused by aortoiliac occlusive disease were prospectively entered into a computerized vascular registry. The decision to perform AOFBG rather than AXFBG was based on assessment of surgical risk and the surgeon's preference. This report describes res ults for surgical morbidity, mortality, patency, limb salvage, and pat ient survival for procedures performed from January 1988 through Decem ber 1993. Results: We performed 108 AXFBGs and 139 AOFBGs. AXFBG patie nts were older (mean age, 68 years compared with 58 years for AOFBG, p < 0.001), more often had heart disease (84% compared with 38%, p < 0. 001), and more often underwent surgery for limb-salvage indications (8 0% compared with 42%, p < 0.001). No significant differences were foun d in operative mortality (AXFBG, 3.4%; AOFBG, < 1.0%,p = NS), but majo r postoperative complications occurred more frequently after AOFBG (AX FBG, 9.2%; AOFBG, 19.4%; p < 0.05). Follow-up ranged from 1 to 83 mont hs (mean, 27 months). Five-year life-table primary patency, limb salva ge, and survival rates were 74%, 89%, and 45% for AXFBG and 80%, 79%, and 72% for AOFBG, respectively. Although the patient survival rate wa s statistically lower with AXFBG, primary patency and limb salvage rat es did not differ when compared with AOFBG. Conclusion: When reserved for high-risk patients with limited life expectancy, the patency and l imb salvage results of AXFBG are equivalent to those of AOFBG.