Repeat axillofemoral grafting as treatment for axillofemoral graft occlusion.
BACKGROUND
Patency of failed axillofemoral (ax-fem) grafts following thrombectomy is so poor, aortofemoral grafts are recommended as treatment for ax-fem graft thrombosis. In patients who are not candidates for aortic grafting, repeat ax-fem grafting is an alternative to thrombectomy. This report compares our experience treating ax-fem graft thrombosis with replacement or revision vs thrombectomy.


METHODS
Patients treated with ax-fem grafts from October 1985 to April 2001 were identified, and those who underwent reoperation for thrombosis were reviewed. Limb salvage and patency of revision procedures (thrombectomy vs repeat ax-fem grafting) were determined using Kaplan-Meier curves.


RESULTS
Three hundred thirty-five patients underwent ax-fem grafting, and 39 (11.6%) of the 335 required reoperation for graft failure. Twenty-five of these 39 patients had 51 operations for graft thrombosis: 42 graft replacements and/or anastomotic revision(s), and 9 thrombectomies. At 18 months, mean +/- SD patency following thrombectomy was 11% +/- 10%, while that for graft replacement or anastomotic revision was 54% +/- 8% (P<.001). Limb salvage at 18 months following revision for thrombosis was 88% +/- 5%.


CONCLUSIONS
The large majority of ax-fem grafts do not require reoperation. For failure due to thrombosis, repeat ax-fem grafting provides excellent limb salvage. Axillofemoral graft replacement and/or anastomotic revision has superior patency to thrombectomy.
Olson
Christine J
CJ
Division of Vascular Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code OP11, Portland, OR 97201-3098, USA.
Edwards
James M
JM
Taylor
Lloyd M
LM
Landry
Gregory J
GJ
Yeager
Richard A
RA
Moneta
Gregory L
GL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001366:Axillary Artery / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome