A Twenty-Year Experience with Axillofemoral Bypass: Analysis of 63 Consecutive Cases

Partially supported by Ministero della Pubblica Istruzione The results of 63 consecutive axillofemoral bypass grafts are presented. A computerized analysis of the data was performed according to the possi-ble variables apt to influence the results of the reconstruction: different indica-tions, stage of disease, previous reconstructions, presence of graft infection, unilateral or bilateral revascularization, iliac artery and runoff status, and graft caliber and material. A higher five-year graft patency rate was obtained with bypasses performed in poor-risk patients with occlusive arterial disease (axil-lounifemoral graft: 53.7%; axillobifemoral graft: 41.6%) than in procedures per-formed in emergency (p < 0.025) or for infection of previous vascular reconstructions (p < 0.001). There was a similar five-year patency rate in axil-lounifemoral and axillobifemoral grafts (p = NS) and in the bypasses performed in patients with iliac artery occlusion or stenosis (p = NS). A higher patency rate was obtained when there were two or three patent tibial vessels (p < 0.001). Fi-nally the authors observed a greater infection rate in polytetrafluoroethylene grafts than in Dacron grafts (p < 0.05). Their results confirm the important role of the axillofemoral bypass in revascularizing high-risk patients with severe limb ischemia (rest pain and necrosis) or patients with graft infection, repeated graft failures, and arterial occlusive disease when laparotomy is contraindicated. at PENNSYLVANIA STATE UNIV on May 9, 2016ves.sagepub.comDownloaded from 67