A comparison of the late patency rates of axillobilateral femoral and axillounilateral femoral grafts.
A total of 130 axillofemoral grafts were peformed in 120 patients from 1966 to present; 66 were axillobilateral femoral moral and 64 were axillounilateral femoral grafts. The average patient age was 66 years. The indications for operation were occlusive disease with rest pain or gangrene in 102 patients, severe claudication four, and bypass of a thoracic aneurysm in one. The one month operative mortality rate was 8 percent (ten patients). Four deaths occurred in elderly patients operated upon as emergencies with acute aortic occlusion. In the 126 elective cases, there were six postoperative deaths (4.7 percent). Twenty thrombectomies were performed in 15 axillobilateral femoral grafts of which 15 (75 percent) were successful. In the unilateral grafts there were 25 thrombectomies in 22 grafts, of which only eight (32 percent) were successful. The 5 year patency rate by the life-table method was 74 percent for axillobilateral femoral grafts and 37 percent for axillounilateral femoral grafts. This difference in patency rates is statistically significant (p < 0.01). Average flow measured by electromagnetic flow meter in six axillobilateral femoral grafts was 621 c.c. per minute and in 11 unilateral femoral grafts was 273 c.c. per minute. We attribute the higher patency rate in axillobilateral femoral grafts to this increased flow. These data indicate that axillobilateral femoral grafts may be performed with anticipation of a 5 year patency rate comparable to that with conventional aortoiliac reconstruction and that axillobilateral femoral grafts should be performed in preference to axillounilateral femoral grafts in poor-risk patients requiring extra-anatomic bypass for aortoiliac occlusive disease.
LoGerfo
F W
FW
Department of Surgery, Boston University, Boston, Mass, USA.
Johnson
W C
WC
Corson
J D
JD
Vollman
R W
RW
Weisel
R D
RD
Davis
R C
RC
O'Hara
E T
ET
Nabseth
D C
DC
Mannick
J A
JA
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001366:Axillary Artery / Q000637:transplantation*; D005263:Femoral Artery / Q000637:transplantation*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality