Twelve year experience with axillofemoral and femorofemoral bypass operations
DeLaurentis, D.A.; Sala, L.E.; Russell, E.; McCombs, P.R.
Surgery Gynecology and Obstetrics 147(6): 881-887
1978
ISSN/ISBN: 0039-6087 PMID: 152476 Document Number: 132101
Femorofemoral bypass, carried out in 13 patients, was an excellent alternative to aortofemoral bypass in patients with unilateral disease, and was the preferred method of reconstruction if these patients had a serious coexisting disease. The axillofemoral bypass, used to revascularize 42 ischemic limbs in 34 poor risk patients, carries a low elective operative mortality and a poor early patency rate. If an axillofemoral graft remains open for more than 1 yr, long term patency results are good. One patient has a patent, unilateral, axillofemoral graft which was inserted over 9 yr ago. Increased graft flow and good peripheral run-off appear to be the factors which contribute most to long term patency. Bilateral axillofemoral grafts, femoral endarterectomy, extended reconstruction of the profunda femoris and the addition of femoropopliteal bypasses seem to increase patency rates. Until better patency rates with axillofemoral grafts are achieved, this operation is not indicated in the good risk patient, but should be considered in treating the following patients: those with infected aortic grafts or mycotic aortoiliac aneurysms; patients with recent myocardial infarctions or congestive heart failure; patients with diabetes and any evidence of heart disease; patients with cancer and sever ischemia of the lower extremities; patients with acute thrombosis of the distal part of the aorta or aneurysm; patients with aortic occlusion at the level of the renal arteries; patients with multiple operations; patients in whom preservation of sexual function is mandatory; and patients with serious renal disease. Age, mild hypertension, transient ischemic attacks and moderate respiratory insufficiency alone are not automatic indications for this operation.