RESULTS OF AXILLOFEMORAL BY-PASSES FOR AORTOILIAC OCCLUSIVE DISEASE

Citation
G. Illuminati et al., RESULTS OF AXILLOFEMORAL BY-PASSES FOR AORTOILIAC OCCLUSIVE DISEASE, Langenbecks Archiv fur Chirurgie, 381(4), 1996, pp. 212-217
Citations number
27
Categorie Soggetti
Surgery
ISSN journal
00238236
Volume
381
Issue
4
Year of publication
1996
Pages
212 - 217
Database
ISI
SICI code
0023-8236(1996)381:4<212:ROABFA>2.0.ZU;2-B
Abstract
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.