The role of extra-anatomic grafts for lower limb ischaemia.

Aorto-bifemoral graft is the conventional treatment for ischaemic lower limbs due to severe aorto-iliac disease. However, some patients are not fit to withstand this major procedure, and for them extra-anatomic grafts provide a method of improving the blood supply to the legs where the alternative may be amputation. The role of these grafts has still not been established because of variable results. We have used the femoro-femoral and the axillo-femoral routes for ten years. The patients were unfit for major surgery and had an overall mortality of 20% in two years. They all presented with critical lower limb ischaemia. Forty-three extra-anatomic grafts have been inserted. Perioperative mortality was less than 2%. None of those undergoing femoro-femoral grafting required subsequent amputation: four amputations were performed in those with axillo-femoral grafts. We conclude that extra-anatomic grafts should be considered before resorting to amputation in patients with critical lower limb ischaemia.