15-YEAR EXPERIENCE IN AXILLOFEMORAL BYPASS WITH EXTERNALLY SUPPORTED KNITTED DACRON PROSTHESIS IN A JAPANESE HOSPITAL

Background: Recently, several reports in the United States have demons trated remarkable improvement in the patency of axillofemoral (AXF) by pass with an externally supported prosthesis. The purpose of this stud y was to review the prognoses regarding graft patency, limb salvage, a nd survival of patients who underwent AXF bypass grafting with an exte rnally supported, knitted Dacron prosthesis (EXS) in a Japanese hospit al and to analyze what factors affected the graft patency. Methods: Th e clinical records of 81 patients with arteriosclerosis obliterans (AS O) who underwent 47 axillounifemoral bypasses and 34 axillobifemoral b ypasses with EXS were retrospectively checked and, by uni- and multiva riate analysis, perioperative factors were evaluated. Results: The cum ulative primary and secondary patency rates of AXF bypass grafts were 81% and 88%, 73% and 80%, and 70% and 77% at 3, 5, and 7 years, respec tively, with no change thereafter. Limb salvage rate was 100%. The ope rative mortality was 3.7% and the survival rate was 63%, 41%, and 35% at 3, 5, and 7 years, respectively. The risk factors adversely affecti ng the patency were age (younger than 75 years), poor distal run-off a nd preoperative leukocyte count (more than 8,000/mu L) by univariate a nalysis, none of which were significant by stepwise multivariate analy sis. Conclusions: AXF bypass using EXS was an acceptable procedure in ASO patients at high risk for conventional anatomic bypass or with lim ited life expectancy, and there was no significant risk factor that in dependently affected the patency. (C) 1998 by the American College of Surgeons.