title: Axillopopliteal bypass for limb salvage.
abstract: Forty-one axillopopliteal bypass grafts have been placed in 30 patients for limb salvage in the past 12 years. The mean patient age was 65.6 years; 8 were women; 19 smoked; and six had diabetes. Sixteen grafts were straight axillopopliteal bypass grafts, and 25 were sequential axillopopliteal bypass grafts. Cumulative life-table primary patency rates at 1, 2, and 3 years were 70%, 56%, and 43%, respectively; secondary patency rates were 73%, 57%, and 50%, respectively. Corresponding limb salvage rates were 86%, 69%, and 69%, respectively. Ringed polytetrafluoroethylene (PTFE) graft patency at 3 years was 61% versus 40% for unsupported PTFE grafts (p = 0.35). Ringed PTFE axillofemoral grafts with sequential femoropopliteal saphenous vein grafts had a 3-year patency of 67%. Graft patency was restored in 25% of occluded grafts by thrombectomy and in 80% of occluded grafts by thrombectomy with graft revision (p = 0.21). Cumulative 3-year patient survival was 48%. The 30-day operative mortality rate was 20%; patients operated on for graft infection had a 30-day operative mortality rate of 36%. The data support the use of axillopopliteal bypass for limb salvage when standard revascularization techniques are contraindicated. Long-term patency is enhanced by use of externally supported PTFE and sequential femoropopliteal saphenous vein.
authors.affiliation: Department of Surgery, University of Missouri-Columbia 65212.
authors.forename: M P
authors.initials: MP
authors.lastname: Keller
authors.forename: J R
authors.initials: JR
authors.lastname: Hoch
authors.forename: A D
authors.initials: AD
authors.lastname: Harding
authors.forename: W K
authors.initials: WK
authors.lastname: Nichols
authors.forename: D
authors.initials: D
authors.lastname: Silver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001366:Axillary Artery / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D016019:Survival Analysis; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene