The purpose of this study was to review our results with axillofemoral
by-passes performed for aortoiliac occlusive disease. Fifty patients
receiving 51 axillofemoral by-passes from January 1989 to December 199
4 were retrospectively reviewed. The 30-day post-operative mortality w
as 4%. Seven patients (14% presented graft-related local complications
and all but one required reoperation. Five patients were lost to foll
ow-up, the mean length of which was 36 months (16-74 months). Forty-ni
ne per cent of the patients died during the follow-up period. At 36 mo
nths, the primary patency rate was 51%, the secondary patency rate was
69%, and limb valvage rate was 57%. A statistical difference was seen
in the secondary patency rate between axillobifemoral by-pass (87%) a
nd axillo-unifemoral by-pass (56%) at 36 months (P < 0.01), but no dif
ference was seen in the limb salvage rate at 36 months between the two
configurations of the by-pass (94% vs 81%) (P=NS). Twenty patients (4
0%) operated upon for acute ischemia had a significantly higher post-o
perative mortality rate (10% vs 0), a significantly higher amputation
rate (20% vs 6.6%) and a significantly lower patency rate of by-pass (
26% vs 63%) (P < 0.01), than the 30 patients (60%) operated on for cla
udication, rest pain or trophic ulcers. Our findings indicate that the
results of axillofemoral by-pass are significantly influenced by the
selection of patients for operation, namely the clinical status of isc
haemic symptoms, and that since the overall results of axillofemoral b
y-pass are inferior to those of aortofemoral by-pass, this treatment s
hould be restricted to patients at high risk of aortic clamping.