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OBJECTIVES:
Axillofemoral bypass is a well-established alternative in patients who are unable to undergo anatomic reconstruction. Two different indications for its use, however, exist: revascularization after treatment of infectious aortic pathology and revascularization for arterial occlusive disease. The goal of this study was to review and update our experience with this operation, specifically focusing on differences in outcome between patients operated upon for infectious versus occlusive problems.
METHODS:
Retrospective analysis of patients undergoing axillo-femoral bypass from January 2000 to December 2012 at a single institution was performed. Patients with revision of an existing graft, temporary grafts during aneurysm repair, and insufficient information or follow up were excluded. Primary endpoints were primary patency, primary assisted patency, secondary patency, limb salvage, and survival, and patients were stratified according to whether the indication for operation was aortic infection (infectious) or aortoiliac occlusive disease (occlusive). Life table analysis with Cox hazard ratios were calculated between groups.
RESULTS:
During this timeframe 112 patients underwent axillo-femoral bypass by 6 surgeons. 59 patients had occlusive versus 48 patients with infectious disease. There were 82 axillobifemoral, 14 axillo-unifemoral, 2 axillo-profunda femoris, and 1 axillo-superficial femoral artery bypass. Operative details were available on 101 patients, and reliable follow up existed on 69. Of the 101 patients analyzed, 30-day mortality was higher in infectious group (25% vs.10%). Overall primary patency at 1,3 and 5 years was 68%, 53% and 53%, while secondary patency at the same intervals was 83%, 73%, and 73%. Primary patency was numerically better in the infectious group (1 year: 81% vs. 65%; 5 year: 67% vs. 50%) although overall differences did not reach significance (P<0.2). Survival was better in the occlusive group (5 years: 70% vs 36%; P<.02), but limb salvage was no different (5 years: 96% vs. 91%, P-value 0.19).
CONCLUSIONS:
In our experience, axillobifemoral bypass in the 21st century is associated with approximately 50% 5-year primary patency and 75% secondary patency. Patency seems to be slightly better in patients operated upon for aortic infectious problems, while survival is better in those operated upon for occlusive disease, likely highlighting the severity of aortic infectious problems.