[Are axillo-distal bypasses justified? Apropos of 70 cases over an 8-year period].

Seventy axillary/distal artery shunts were carried out in 67 patients between 1978 and 1985. Mean age of patients was 71.5 years; 34% had coronary disease, 39% respiratory insufficiency, 12% diabetes and 12% severe renal impairment. Indications for the operation were sepsis in Scarpa's triangle (5 cases) and to save a limb with major ischemic lesions (65 cases including 14 stage III, 28 stage IV and 23 acute ischemic lesions). One-stage operation was performed in 37 cases and a two-stage procedure in 33. In 80% of cases the distal artery was the upper popliteal (11 cases) or lower popliteal (45 cases) artery. In 14 cases the distal artery was either the fibular (6 cases) anterior tibial (4 cases) or posterior tibial (4 cases) artery. Allowing for the context, the results justify this "maximalist" attitude (16% operative mortality, 43 limbs saved at 6 months, 31 at 1 year, 19 at 2 years). Three factors are determinant for permeability of shunts: severity of initial clinical stage, level of distal anastomosis and type of material used.