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

ABSTRACT

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.