Unilateral aortofemoral bypass: a safe and effective option for the treatment of unilateral limb-threatening ischemia.
To determine whether unilateral aortofemoral (AUF) bypass is a safe and effective option for the treatment of unilateral limb-threatening ischemia in patients with aortic or bilateral iliac occlusive disease, we reviewed the results of 42 AUF bypasses performed using polytetrafluoroethylene grafts in patients operated on for limb salvage; 11 (26%) of the patients also underwent femoropopliteal or femorodistal (FP/D) bypasses. The indications for surgery were tissue necrosis or ulceration in 18 (43%) patients and rest pain in 17 (40%) patients. The 5-year primary graft patency and limb salvage rates for AUF bypass were 74% and 84%, respectively. The perioperative mortality rate was 5%. There were no significant differences in the primary graft patency or limb salvage rates in patients who underwent AUF bypass with or without FP/D bypass. Only 3 of 41 (7%) AUF bypass patients required subsequent femorofemoral bypass. We conclude that: (1) AUF bypass is a safe and effective surgical option in patients with unilateral limb-threatening ischemia and aortic or bilateral iliac occlusive disease; (2) the routine performance of an aortobifemoral or axillobifemoral bypass in patients with unilateral limb-threatening ischemia may be unnecessary; and (3) AUF bypass facilitates the combined inflow and infrainguinal operations that are frequently required for limb salvage in these patients.
Kram
H B
HB
Division of Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York 10467.
Gupta
S K
SK
Veith
F J
FJ
Wengerter
K R
KR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D013997:Time Factors
D011138:Polytetrafluoroethylene