Extra-anatomical bypass grafting--a single surgeon's experience.
BACKGROUND
Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes.


METHODS
A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004.


RESULTS
Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery.


CONCLUSIONS
Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage.
Appleton
N D
ND
Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK.
Bosanquet
D
D
Morris-Stiff
G
G
Ahmed
H
H
Sanjay
P
P
Lewis
M H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001366:Axillary Artery / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D014654:Vascular Patency