Disruption of the proximal anastomosis of axillobifemoral grafts: Two case reports (original) (raw)
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Upper extremity thromboembolism caused by occlusion of axillofemoral grafts
The American Journal of Surgery, 1995
Oregon P rosthetic bypass grafting from the axillary artery to the femoral arteries was first performed by Louw' and by Hall and Blaisdel12 in 1962. Axillofemoral bypass has become the treatment of choice for infected aortic prostheses, as well as aortoiliac occlusive disease in high-risk pa-
Disruption of proximal axillobifemoral bypass graft anastomosis
Journal of Vascular Surgery, 1992
Anastomotic dismption ofaxillobifemoral bypass grafts is a rare but serious complication. Previously described causes of anastomotic disruption include the following: infection, technical errors, and severe mechanical stress. In this report we describe a proximal anastomotic disrnption of an axillobifemoral bypass graft in which the suture line remained intact on the axillary artery and tore through the polytetra1luoroethylene graft. This suggests a possible role of material failure contributing to axillobifemoral anastomotic disruption.
Annals of Vascular Surgery, 2009
Proximal disruption of an axillofemoral bypass is a catastrophic event rarely caused by a posttraumatic anterior dislocation of the shoulder. Herein, we present a 74-year-old man with a painful dislocation of the right shoulder that was successfully reduced. Three hours later he had hemodynamic shock with an expanding and pulsating hematoma at the level of the right shoulder, pectoral and infraclavicular region. Surgical exposure of the right brachial artery was carried out, and intraoperative angiography revealed a proximal anastomotic leakage. The distal ballooning improved the hemodynamic status, and by a redo infraclavicular incision the hematoma was drained. The arterial leak was repaired by an 8 mm polytetrafluoroethylene interposed graft between the axillary artery and existing graft. The utility of a combined approach (endovascular + open surgical) is discussed.
Endovascular management of axillofemoral bypass graft stump syndrome
Journal of Vascular Surgery, 2003
Objective: Upper extremity embolic complications of occluded axillofemoral bypass grafts are infrequent. However, traditional management of dissection of axillary anastomosis for removal of the stump can be challenging. We report two patients with critical upper extremity ischemia secondary to stump syndrome and its successful management with endovascular techniques.
Axillobifemoral Bypass: A Brief Surgical and Historical Review
Einstein Journal of Biology and Medicine, 2017
Peripheral artery disease (PAD) occurs when plaque accumulates in the arterial system and obstructs blood flow. Narrowing of the abdominal aorta and the common iliac arteries due to atherosclerotic plaques restricts blood supply to the lower limbs. Clinically, the lower limb symptoms of PAD are intermittent claudication, discoloration of the toes, and skin ulcers, all due to arterial insufficiency. Surgical revascularization is the primary mode of treatment for patients with severe limb ischemia. The objective of the surgical procedure is to bypass a blockage in an occluded major vessel by constructing an alternate route for blood flow using an artificial graft. This article presents information on aortoiliac reconstruction, with an emphasis on axillobifemoral bypass grafting.
Management of failed and infected axillofemoral grafts
Journal of Vascular Surgery, 1994
The purpose of this study was to review the treatment of patients with failed or infected axillofemoral bypass grafts and to determine the efficacy of remedial procedures in maintaining graft patency and limb preservation. Methods: Thirty-four patients with 37 failed or infected axillofemoral grafts were retrospectively reviewed. In nine cases there was no attempt at revascularization, and in the remaining 28 cases, a total of 52 remedial procedures was performed. Nine were performed in patients with graft infection and 43 in patients with graft thrombosis. In patients with axillofemoral graft failure, 21 thrombectomies, 13 graft revisions, and 9 secondary reconstructions were performed. Eighty-eight percent of patients were monitored at least 2 years or until graft failure. Results: Eight of nine patients receiving no remedial procedure required major amputation. The limb salvage rate was 64%-+ 11% at 30 months in the 25 patients undergoing remedial procedures. Twenty-eight percent of failed axiUofemoral grafts remained patent at 2 years after initial failure with single or multiple thrombectomies or revisions. Life-table primary patency after secondary reconstructions (81%-+ 10.9% at 24 months) was significantly better than after thrombectomy alone (10%-+ 4.2% at 24 months) or graft revision (16%-+ 10.6% at 24 months) by log-rank test (p < 0.001 andp < 0.005, respectively). Patients undergoing reconstruction with descending thoracic aorta to femoral artery bypass had an 89%-+ 11% patency rate at 24 months. Graft infection resulted in a perioperative mortality rate of 22% and amputation in 57% of survivors. Conclusion: Axillofemoral graft failure most often results in limb loss without remedial procedures. Thrombectomy and revision procedures had poor long-term patency rates and salvaged only a minority of grafts despite multiple procedures. Reconstruction by use of an alternate source of inflow such as the descending thoracic aorta resulted in better long-term patency rates in patients well enough to tolerate a major reoperative procedure.
Iatrogenic Entrapment: Femoro-popliteal Vein Bypass Graft
Current Surgery, 2006
A rare cause of occlusive vascular disease is the "Popliteal Artery Entrapment Syndrome." The most common cause of this problem is abnormal position of the popliteal artery caused by abnormal migration of the medial head of the gastrocnemius. An acquired form can occur because of tunneling defects by inadvertent placement of venous bypass graft medial to the medial head of the gastrocnemius muscle.
Axillofemoral bypass: Compromised bypass for compromised patients
Journal of Vascular Surgery, 1994
The procedure of axillofemoral bypass (AXF) grafting has generaUy been used in the past for patients with serious contraindication to certain reconstructive procedures involving the abdominal aorta. Because some recent series have noted improved results, it has been suggested that the indications for this bypass may be extended. We reviewed our experience with AXF to identify which factors affect outcome, to determine whether recent results have improved, and to determine whether an extension of the use of the procedure is justified by the observed results. Method: One hundred fifty-three AXF, including 80 axillobffemoral bypasses and 73 axiUounifemoral bypasses performed between October 1974 and December 1992 were reviewed. Results: Three-year primary and secondary patency rates for the entire group were 49.4% and 65.7%. Primary patency was adversely affected (20 < 0.05) by superficial femoral artery occlusion, use of externally supported polytetrafluoroethylene, distal endarterectomy, distal anastomosis to the deep femoral artery, and year of surgery after 1984, but not by use of unifemoral or bifemoral outflow, side of graft origin, or concomitant distal procedure. The operative mortality rate of bypasses performed for claudication and the limb salvage rate was 8.3% overall and 5.9% after 1984. Limb salvage rates were 74.8% and 74.8% at 3 and 5 years. The patient survival rate for all AXF was 55.8% and 39.2% at 3 and 5 years. AXF for acute ischemia carried a high rate of mortality and limb loss. Conclusion: Bifemoral outflow, external support, and more recent surgery were not associated with improved patency rates. Our results do not support extended indications for AXF.