AXILLOBIFEMORAL BYPASS - ELECTIVE VERSUS EMERGENT OPERATION

Axillobifemoral bypass (AxBFB) is considered an inferior operation bec ause of comparatively poor long-term results. One factor that has not been considered in the literature is whether or not the operation is p erformed electively or for acute ischemia (< 24 hours duration). This may be a more important predictor of poor results than previously reco gnized. During the last 10 years, we have performed 59 AxBFB. In Group A, 41 patients (mean age 71) underwent elective AxBFB and in Group B, 18 patients (mean age 65) had emergency AxBFB. Indications for surger y in Group A were limb-threatening ischemia (30), infected aortic graf t (5), and severe claudication (6); in Group B, indications for surger y were acute limb ischemia (16), and aortoduodenal fistula (2). Primar y patency (p < 0.002), limb salvage (p < 0.002), and survival (p < 0.0 3) were significantly better in Group A versus Group B. We conclude th at an AxBFB performed electively provides satisfactory palliation of s evere vascular disease in high-risk patients. The indications for oper ation and timing of the operation may explain the widely disparate cli nical results reported in the literature.