Extra-anatomic reconstruction.

Extra-anatomic bypass grafts have proven to be effective in bypassing infected regions, in avoiding hostile abdomens, and in patients with limited life expectancy. The extra-anatomic bypass graft can be used as a temporizing conduit while infected fields are definitively treated. The recommendation to expand the role of extra-anatomic bypass grafts over more direct revascularization with an aortobifemoral artery bypass graft must be critically evaluated. With advances in anesthesia and critical care management, the postoperative mortality for aortobifemoral bypass is 3% to 5%, with an incidence of myocardial infarction of 2%. Long-term primary patency of the aortofemoral bypass graft is 80% to 92% at 5 years. The 5-year primary patency rate for the axillofemoral bypass graft of 50% to 73% does not strongly support the expanded role of extra-anatomic bypass in otherwise healthy patients undergoing aortoiliac bypass. Yet the extra-anatomic bypasses have a vital role in the management of selected patients and should be in the armamentarium of all vascular surgeons.