Unilateral lower extremity inflow procedures: Is there a preferred operation?

There is no consensus on optimal surgical treatment of unilateral aortoilia c occlusive disease. The purpose of this study was to compare indications f or and results of the various options. Patients undergoing primary, unilate ral inflow procedures without adjunctive infrainguinal bypass over a 10-yea r period were analyzed. Groups were defined as AxF for unilateral axillofem oral bypass (18); IF for aortounifemoral (two) or ipsilateral iliofemoral ( 29) bypass; and CF for contralateral iliac-to-femoral (six) or femorofemora l (10) bypass. Risk factors, level and severity of occlusive disease, morbi dity, mortality, cumulative primary patency, and limb salvage were compared . Median age was 72 years, limb salvage was the surgical indication in 61% of patients. Infrainguinal occlusion was present in 76.6% of the whole grou p, while 27.7% had prior outflow procedures. Compared with the other groups , AxF patients were older with more comorbidity and had more contralateral iliofemoral occlusive disease (88.9% vs 48.4%, p < 0.01). IF patients more frequently had prior outflow operations (48.4% vs 11.1%, p < 0.01). Comorbi dity and presence of contralateral iliac disease most strongly influenced o peration choice. Overall, hospital mortality rate was 3.1% and morbidity ra te was 21.5%, not significantly different between groups. Early occlusion o ccurred in three patients, two IF and one AxF. Life-table primary patency r ate was 87.8% (SE +/- 4.9%) at 2 years and was not significantly different among the groups. Three patients ultimately required contralateral inflow p rocedures, 2 AxF, 1 IF (p = NS). Unilateral inflow operations achieve reaso nable patency and good limb salvage rates. Shorter length reconstructions w ere utilized preferentially when contralateral disease was not severe, but despite greater age, comorbidity, and occlusive disease, axillounifemoral b ypass results were not inferior to more direct reconstructions.