Axillary-popliteal artery bypass provides successful limb salvage after removal of infected aortofemoral grafts.

Axillary-popliteal artery bypasses were placed to revascularize 28 extremities for 17 patients who were undergoing removal of infected aortofemoral grafts. Polytetrafluoroethylene (PTFE [polytef]) material was anastomosed to the above-knee popliteal artery in 22 cases and to the below-knee popliteal artery in six limbs. All but one patient had axillary-popliteal grafts in place before excision of the aortic graft. In 12 groins, vein-patch angioplasty was performed after removal of the infected aortic graft to provide retrograde pelvic perfusion and maintain femoral patency for future reconstruction. Three patients (18%) died of septic-related, multisystem organ failure. With a mean follow-up of 25 months, primary patency was 75% at 1 year and 43% at 2 years. Secondary patency, maintained by thrombectomy (n = 7), revision (n = 3), and conversion to warfarin sodium (Coumadin) therapy (n = 6) was 100% at 2 years, and limb salvage was achieved for all surviving patients.