Lower extremity revascularisation with axillo-femoral bypass grafting in 28 patients.

A subcutaneously tunneled Dacron graft shunt from the axillary to the femoral artery was used to bypass occlusive aortoiliac disease in 19 patients, and to revascularize ischaemic lower limbs after removal of infected aortoiliac prosthesis in 9 patients. Two high risk patients of the former group died postoperatively. Operative mortality was high, 5 of the 9 patients, when treating complications of aortoiliac grafting. Massive bleeding through the axillo-femoral prosthesis resulted in one operative death. In another case, reoperation for graft bleeding was required. The most usual complication of axillo-femoral grafting was thrombosis which occurred in 11 patients. Another late complication was infection of the graft which developed in 4 patients. In two of these, femoral amputation was required. Only 8 of the 28 patients have been free of any complication. At follow-up (mean 9.9 months), 16 of the 19 survivors had a functioning graft (84%). The high complication rate suggests that axillo-femoral bypass should be reserved only for limb salvage in patients with contraindications for conventional aortofemoral surgery.