Results of axillofemoral by-passes for aorto-iliac occlusive disease.
The purpose of this study was to review our results with axillofemoral by-passes performed for aorto-iliac occlusive disease. Fifty patients receiving 51 axillofemoral by-passes from January 1989 to December 1994 were retrospectively reviewed. The 30-day post-operative mortality was 4%. Seven patients (14%) presented graft-related local complications and all but one required reoperation. Five patients were lost to follow-up, the mean length of which was 36 months (16-74 months). Forty-nine per cent of the patients died during the follow-up period. At 36 months, the primary patency rate was 51%, the secondary patency rate was 69%, and limb valvage rate was 87%. A statistical difference was seen in the secondary patency rate between axillobifemoral by-pass (87%) and axillo-unifemoral by-pass (56%) at 36 months (P < 0.01), but no difference was seen in the limb salvage rate at 36 months between the two configurations of the by-pass (94% vs 81%) (P = NS). Twenty patients (40%) operated upon for acute ischemia had a significantly higher post-operative mortality rate (10% vs 0), a significantly higher amputation rate (20% vs 6.6%) and a significantly lower patency rate of by-pass (26% vs 63%) (P < 0.01), than the 30 patients (60%) operated on for claudication, rest pain or trophic ulcers. Our findings indicate that the results of axillofemoral by-pass are significantly influenced by the selection of patients for operation, namely the clinical status of ischaemic symptoms, and that since the overall results of axillofemoral by-pass are inferior to those of aortofemoral by-pass, this treatment should be restricted to patients at high risk of aortic clamping.
Illuminati
G
G
Fourth Department of Surgery, University of Rome, Italy.
Calio
F G
FG
Mangialardi
N
N
Bertagni
A
A
Vietri
F
F
Martinelli
V
V
D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality*; D011475:Prosthesis Failure; D015996:Survival Rate
D011138:Polytetrafluoroethylene