AXILLOFEMORAL GRAFTING WITH EXTERNALLY SUPPORTED POLYTETRAFLUOROETHYLENE

Objective: To evaluate the results of axillofemoral bypass grafting us ing externally supported polytetrafluoroethylene. Design: Consecutive patients who were operated on by us from 1983 to the present were pros pectively followed up in a vascular registry. The results of surgery w ith respect to morbidity and mortality, patency, limb salvage, and pat ient survival were determined by life-table methods. Patients: A stand ardized operative technique was used to perform 184 axillofemoral bypa ss procedures in 164 consecutive patients (age range, 14 to 90 years; mean age, 67 years; female, 33%). Follow-up ranged from 0 to 95 months (mean, 23 months). Results: Ischemia was the indication for 83% of th e procedures, and aortic sepsis was the indication for 16%. There were nine operative deaths (5%) and 17 major complications. Life-table pri mary patency, limb salvage, and survival rates at 5 years were 71%, 92 %, and 52%, respectively. Indication for surgery, patency of the super ficial femoral artery, and the performance of multilevel procedures di d not significantly influence patency. Conclusions: The results of axi llofemoral grafting using polytetrafluoroethylene are equivalent to th ose achieved with other accepted methods of treatment for lower extrem ity ischemia, including balloon angioplasty, aortofemoral bypass, and infrainguinal bypass. Axillofemoral bypass is an appropriate technique that is deserving of more widespread use.