Axillobifemoral Bypasses: Reappraisal of an Extra-Anatomic Bypass by Analysis of Results and Prognostic Factors.

BACKGROUND

Axillobifemoral bypass (AFB) is method of second choice. It is reserved for patients at high operative risk or to bypass infected vessels or grafts. In this study, we analyzed prognostic factors for AFB patency and limb salvage rate to facilitate the choice of procedure.

METHODS

Between Jan 2006 and Aug 2013, 45 patients underwent AFB surgery in our department, 24 for critical limb ischemia (CLI) and 23 for infection. Endpoints of study were graft occlusion, graft infection, amputation and patient's death. Prognostic factors were compared by univariate analysis for each indication group. Mean follow-up was 40.2 (±23.2) months.

RESULTS

Complication rate was significantly higher in infection group (88.0 vs. 54.4%, p = 0.003) and in emergency surgery (83.3 vs. 56.9%, p = 0.023). Overall primary patency rate after AFB procedures was 66.7% after 1, 3, and 5 years, while secondary patency rate was 91.1% after 1 year, 82.2% after 3 years and 80.0% after 5 years. The primary and secondary patency rates did not significantly differ between the both groups (p = 0.059 and p = 0.136). Following prognostic factors showed a statistically significant influence on patency rates in CLI group: >1 previous vascular surgical intervention, patch angioplasty at the distal anastomosis site, complications after previous vascular surgery, and perioperative intake of platelet aggregation inhibitor. Only the employed bypass material had a statistical significant influence on the secondary patency rates in the infection group. Overall limb salvage rate was 82.2% after 1 year, 80.0% after 3 years and 77.8% after 5 years. There were statistically significant differences in the limb salvage rates depending on emergency surgery and a 3-vessel-run-off in the lower leg in both indication groups.

CONCLUSION

AFB have acceptable patency and limb salvage rates. AFB is a good alternative in patients with CLI at high operative risk or with infections of aortoiliac segments, even with endovascular approaches. They remain essential tools in vascular surgeon's repertoire.