Present role of extraanatomic bypass graft procedures for aortoiliac occlusive disease.

In a retrospective follow-up the long-term results and present role of axillofemoral and transverse femorofemoral bypass grafts are evaluated. During the period from 1970 until 1989 173 extraanatomic bypass operations were carried out on 150 high risk patients. There were 131 axillofemoral and 42 femorofemoral bypass grafts. In elective operations the mortality ranged from 5.3% for the axillofemoral bypass and 2.4% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate of 86.82% for the femorofemoral bypass, 73.74% for the axillo-bifemoral bypass and 43.18% for the unilateral modification. After ten years the results of femorofemoral bypass remained unchanged. In contrast nearly every second axillofemoral bypass showed one to five graft occlusions. Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure on the one hand femorofemoral bypass has presented more and more as surgical method of choice in cases of unilateral iliac artery occlusion and unilateral branch occlusion of aortoiliac bifurcation grafts as well. On the other hand in cases of bilateral occlusive disease in high risk patients axillofemoral bypass has been displaced more and more by anatomical surgical procedures as endarterectomy or unilateral bypass using retroperitoneal approach. Since 1986 axillofemoral bypass has no longer been performed in elective cases. Nowadays an indication does exist only for deep wound infection in retroperitoneal or inguinal space.