Axillofemoral bypass for aortoiliac occlusive disease

BACKGROUND: Although aortoiliac disease remains a common cause of lower ext remity ischemia, the efficacy of axillofemoral bypass in this setting remai ns controversial. This report summarizes our institutional experience with axillofemoral bypass. METHODS: A retrospective review of consecutive axillofemoral bypass grafts was performed at a single institution between 1984 and 1997. Only patients presenting with chronic aortoiliac occlusive disease were included. Patient demographics, risk factors, indications for surgery and outcomes were reco rded. Survival curves for primary patency were plotted using the Kaplan-Mei er method according to the standards set by the Society of Vascular Surgery -International Society for Cardiovascular Surgery. Comparisons between grou ps were made using the log rank method. Statistical significance was assume d at P values <0.05. RESULTS: Sixty patients underwent axillofemoral bypass grafting of which 53 were bifemoral and 8 unifemoral, Forty-seven procedures were performed for limb salvage. Primary patency rates at 1, 3, and 5 years were 86%, 72%, an d 63%, respectively. Thirty-day mortality rate was 4.9%. Sixty percent of g raft occlusions occurred in the femorofemoral limb with continued patency o f the axillofemoral limb. Risk factors, type of procedure and superficial f emoral artery patency had no statistically significant effect on longterm p atency. CONCLUSIONS: In the setting of diffuse, chronic aortoiliac occlusive diseas e, long-term patency rates of axillofemoral grafts approach those of aortob ifemoral bypass and exceed those quoted for percutaneous transluminal angio plasty, with results that are highly reproducible. Axillofemoral bypass is an excellent option in those patients at prohibitive risk for direct aortic reconstruction or those with limited life expectancy. Am J Surg. 2000;180: 100-103. (C) 2000 by Excerpta Medica, Inc.