ACUTE DISRUPTION OF POLYTETRAFLUOROETHYLENE GRAFTS ADJACENT TO AXILLARY ANASTOMOSES - A COMPLICATION OF AXILLOFEMORAL GRAFTING

Purpose: Acute disruption at or adjacent to axillary anastomoses of ax illofemoral grafts has been sporadically reported We have recently rep orted the patency and limb salvage results of a large number of axillo femoral grafts. In this report we describe a series of axillary artery -graft disruptions that occurred in these patients. Methods: Beginning in 1983, axillofemoral bypass was performed by the authors using stan dardized operative technique and a single prosthetic graft material (8 mm externally supported polytetrafluoroethylene). Axillary anastomose s were placed on the first portion of the artery and were performed wi th the arm abducted and with the graft redundant. The records and oper ative reports of all patients with disruption were reviewed for findin gs and subsequent hospital course. Results: Two hundred two axillofemo ral grafts mere performed from 1983 to 1993. Ten patients (5%) had axi llary disruption at intervals ranging from 1 to 46 days (mean 21 days) after operation. Ischemia was the indication for operation for seven of the patients and infected aortic prostheses for three. Infection di d not occur in any of the axillary wounds and was not the cause of any of the disruptions. Four disruptions occurred with arm abduction/shou lder elevation movements; three awakened patients from sleep, and one occurred while the patient was sitting quietly. For the other two pati ents, preceding activity was unknown. Brachial plexus deficit was pres ent in one patient. Pour of the 10 disrupted grafts were also acutely occluded. Operative findings included sutures pulling out of the arter y in four cases, tearing or sutures pulling out of the graft in four c ases, and cause unknown in two cases. Treatment included arterial liga tion in one patient, and restoration of circulation through revision o f the axillofemoral grafts in the other nine patients. There were no o perative deaths. One patient had a prolonged hospital course followed by nursing home placement and died 9 months later. The brachial plexus deficit did not resolve. There have been no repeat disruptions. Concl usions: We conclude that axillofemoral grafting includes the potential for disruption of the proximal anastomosis, which has occurred in 5% of our patients. Although multiple steps have been recommended to avoi d this complication, occasional cases continue to occur despite observ ing all precautions.