AXILLOFEMORAL BYPASS - COMPROMISED BYPASS FOR COMPROMISED PATIENTS

Purpose: The procedure of axillofemoral bypass (AXF) grafting has gene rally been used in the past for patients with serious contraindication to certain reconstructive procedures involving the abdominal aorta. B ecause some recent series have noted improved results, it has been sug gested that the indications for this bypass may be extended. We review ed our experience with AXE to identify which factors affect outcome, t o determine whether recent results have improved, and to determine whe ther an extension of the use of the procedure is justified by the obse rved results. Method: One hundred fifty-three AXF, including 80 axillo bifemoral bypasses and 73 axillounifemoral bypasses performed between October 1974 and December 1992 were reviewed. Results: Three-year prim ary and secondary patency rates for the entire group were 49.4% and 65 .7%. Primary patency was adversely affected (p < 0.05) by superficial femoral artery occlusion, use of externally supported polytetrafluoroe thylene, distal endarterectomy, distal anastomosis to the deep femoral artery, and year of surgery after 1984, but not by use of unifemoral or bifemoral outflow, side of graft origin, or concomitant distal proc edure. The operative mortality rate of bypasses performed for claudica tion and the limb salvage rate was 8.3% overall and 5.9% after 1984. L imb salvage rates were 74.8% and 74.8% at 3 and 5 years. The patient s urvival rate for all AXF was 55.8% and 39.2% at 3 and 5 years. AXF for acute ischemia carried a high rate of mortality and limb loss. Conclu sion: Bifemoral outflow external support, and more recent surgery were not associated with improved patency rates. Our results do not suppor t extended indications for AXF.