A Case of Axillofemoral Bypass Graft Stump Syndrome Occurring in Both the Upper and Lower Extremities / 日本心臓血管外科学会雑誌

Acute ischemia due to thromboembolism caused by occluded prosthetic graft after axillary-femoral artery bypass has been reported as axillofemoral bypass graft stump syndrome (AxSS). AxSS usually occurs in the upper extremities and it is rare that it occurs in the lower extremities. We encountered a rare case of a 76-year-old woman with acute right upper and lower extremities ischemia 4 years after right axillary-external iliac artery bypass grafting. The graft and the native arteries of the right upper and lower limbs were occluded. In addition, the right axillary artery and proximal anastomotic site were deformed. We diagnosed acute limb ischemia due to AxSS and immediately performed thrombectomy. Because we considered the thrombosis to originate from the axillary-iliac artery bypass graft, we disconnected the occluded graft from the native arteries. Six months after surgery, she was doing well without recurrence of thromboembolism. We report here the successful treatment of a case of AxSS that developed in both the upper and lower extremities.

Follow-up Results in Patients Underwent Axillo-femoral Bypass for Aortoiliac Occlusive Disease

PURPOSE: Axillofemoral bypass for aortoiliac occlusive disease is a type of extra-anatomic bypass with varying reputations. This study was performed to observe early and late outcomes in patients underwent axillofemoral bypasses. METHOD: We retrospectively reviewed 25 patients who underwent 16 elective and 9 emergent axillofemoral bypasses. Mean age of patients was 72.5 years. Coexisting medical conditions included hypertension in 44%, ischemic heart disease in 28%, diabetes in 20%, chronic obstructive pulmonary disease in 20%, malignant tumor in 12% and cerebrovascular disease in 8%. All patients were presented with critical leg ischemia except for 2 with short-distance claudication. Axillofemoral bypass was performed under general anesthesia making configuration of inverted C shaped femoro-femoral bypass and redundant axillo-femoral limb using 8 mm ringed PTFE graft. RESULT: Two operative mortality occurred after emergent operations. Long-term folow-up results revealed 1 and 3 year primary graft patencies were 88% and 36% in the emergent operation group and 75% and 56% in the elective operation group. Limb salvage rates were 92% and 87% at 1 and 3 years respectively. Patient survival at 1 and 3 years after bypass operations were 78%, 22% in the emergent operation group and 86% and 54% in the elective operation group respectively. However, the differences between these 2 groups were not statistically significant. CONCLUSION: After performing 16 elective and 9 emergent axillofemoral bypasses for patients with higher surgical risk and poor distal runoff arteries, we experienced rather higher operative mortality, leg amputation rates and poor follow-up results. However, in the case of very high risk patients with no other treatment option, axillofemoral bypass can be, not only a limb saving, but a life saving procedure.

Kinking of Axillobifemoral Bypass Graft: A case report

Axillofemoral bypass has been the preferred procedure for high risk patients who have aorto-iliac occlusive disease since the introduction of the procedure by Blaisdell in 1963. Widespread use of axillo- femoral bypass was limited in the past because long-term patency rates were inferior to aorto-femoral bypass. Since the mid-1980s, patency rates achieved with axillofemoral bypass have improved with the use of the externally supported prosthesis and the evolution of surgical thchnique. Reported pimary patency of axillo-femoral bypass is in excess of 70% at 5 years. Nowadays axillo-femoral bypass is a procedure of choice in elderly patients with associated comorbid risk factors, and its results is comparable to aorto-femoral bypass.The authors experienced one case of graft malfunction due to kinking of the graft at mid-portion which may not be infrequent.