Axillofemoral Bypass for Critically Ischemic Lone Lower Limb A Mercy (original) (raw)
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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.
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.
The Outcome of the Axillofemoral Bypass: A Retrospective Analysis of 45 Patients
World Journal of Surgery, 2009
Purpose This study was designed to retrospectively analyze outcomes of axillofemoral bypass (AxFB) operations performed in patients with severe comorbidities. Methods All patients (n = 45) who received an AxFB between 1990 and 2005 for aortoiliac occlusive disease (AIOD, n = 35) or infectious aortic disease (IAD, n = 10) were included. Information on patency of the bypass and mortality was retrieved from patient records. A Kaplan-Meier survival analysis was performed to illustrate survival rates, limb salvage, and primary and secondary patency. Results Included patients had several comorbidities and a high operative risk. In this group, a 30-day mortality rate of 20% was found: 17% for the AIOD group, and 30% for the IAD group. During 5-year follow-up 20 patients died, of which 15 during the first year after operation. Survival rates were at 64 and 41% at 1 and 5 years and limb salvage rates were 84% for both these years. Primary patency rates at 1 and 5 years were 72 and 58%, respectively, and secondary patency rates were 86% at both time points. Conclusions High mortality rates were found in AIOD or IAD patients who received an AxFB. However, for high-risk patients with an already reduced life expectancy, the AxFB remains an alternative with acceptable patency rates.
Improved patency after axillofemoral bypass for aortoiliac occlusive disease
Journal of vascular surgery, 2018
Axillofemoral bypasses (AxFBs) have been used since 1962 to treat aortoiliac disease. In the past, reported patency rates (37%-76%) for these extra-anatomic grafts have been inferior to those for anatomic aortic grafting. Reported low survival rates after AxFB (40%-50%) have confirmed that these procedures have been used primarily in patients at high risk for complications from aortofemoral bypass. However, modern medical and anesthesia management, preoperative scanning, donor artery preparation, postoperative graft surveillance, and graft technology may improve outcomes after AxFB, possibly supporting expansion of its use. We therefore report our last 15-year experience with AxFB. Ring-reinforced, 8-mm expanded polytetrafluoroethylene grafts were used in all cases. The cross-femoral limb of axillobifemoral bypass (AxBFB) grafts was preconstructed. Heparin was administered intraoperatively, with protamine reversal. Loss of primary patency was defined as graft thrombosis of part or a...
American Journal of Case Reports, 2020
Unusual clinical course Background: An extra-anatomic bypass is the choice of revascularization method for limb salvage in patients with infra-renal aortailiac occlusion accompanied by severe comorbidities. Case Report: We report a case of aortailiac-occlusive disease in a 59-year-old man with severe cormobidities. He had complained about intermittent claudication in both lower limbs for the past 10 years. The condition had worsened over the last 5 months, making it difficult for him to walk. Three attempts had been made at percutaneous aortailiac stenting, all of which were unsuccessful. The patient had a history of coronary artery disease and complete revascularization by percutaneous coronary stenting 10 years ago. Extra-anatomic axillounifemoral bypass was performed under general anesthesia. The results were good, with improvement in the patient's distal perfusion immediately and at 1-month follow-up. Conclusions: After failed aortoiliac stenting, when direct revascularization aortofemoral bypass and endovascular intervention could not be carried out, extra-anatomic axillofemoral bypass was effective for revascularization in a patient with aortoiliac-occlusive disease and severe comorbidities.
Indications and Role of Axillofemoral Bypass in High-Risk Patients
Annals of Vascular Surgery, 1988
The purpose of this study was to determine whether axlllofemoral bypass was justified as an alternative revascularlzatlon procedure to direct reconstruction and to specifically define the Indications for this extraanatomlcal bypass. Forty-one patients operated on between 1978 and 1985 were evaluated. The average age was 69 years. Indications were based upon 11mb salvage for aortollllac occlusive disease In the following situations: Infected aortoblfemoral bypass graft (8 patients) and high risk with co-existing medical problems (33 patients). Patients were classified according to Goldman's Multifactorial Index of Cardiac Risk and Cooperman's Cardiovascular Risk Index. Twenty-four patients had axlllobifemoral bypass and 17 had unilateral axlllofemoral procedures. In 66 femoral anastomoses there were 13 extended profundaplastles, 25 profunda arterioplasties, 11 profunda patch angloplastles and 16 anastomoses to the common femoral artery. Postoperative mortalIty was 4.8% (2 patients). Cumulative survival at 60 months was 43% ± 11% and primary patency rate of the axlllofemoral bypass was 69 ± 9.8%. We conclude that axlllo-femoral bypass Is Indicated In the presence of Infection, In patients who fall Into Goldman's Class III-IV or In patients with risk> 10% as calculated by Cooperman's equation.
Axillo-Bipopliteal Bypass Application in Critical Leg Ischemia
kosuyolukalpdergisi.com
We performed an extended extra-anatomic bypass to salvage the both lower extremities in a diabetic and obes woman who had critical ischemia in her both lower extremities. Patient also had several abdominal operations. The patient did not have a good arterial vas-culature ...
Local and Regional Anesthesia, 2010
For an active, ambulant patient with critical, lower limb ischemia, amputation can lead to a poor quality of life. A small group of older people with critical limb ischemia are considered at high risk for revascularization under conventional anesthesia owing to their comorbid conditions. In these cases, when endovascular therapy is not an option, the decision to amputate or revascularize presents a dilemma, especially in ambulant patients. In this article, we present 2 cases in which the individuals had diabetic foot gangrene, rest pain, and multiple comorbidities, and were unfit to undergo conventional anesthesia. In addition, they had severe aortoiliac occlusive disease, which cannot be managed by endovascular methods. Both patients were living independently and were ambulant before their foot ulcer and ischemia. They underwent an axillofemoral bypass under local anesthesia. The postoperative course was uneventful. After a 3-year follow-up, both patients continue to be ambulant and have no complaints. With selective use of local anesthetic techniques, surgical teamwork to shorten the procedure time, and close meticulous postoperative care, an axillofemoral bypass can enable limb salvage for ambulant patients who are considered unfit for conventional anesthesia.
Journal of Vascular Surgery, 1993
The purpose of this study was to review our experience with externally supported, knitted Dacron grafts used for axiUofemoral bypass. Methods: Retrospective analysis was performed on records of 79 consecutive axillofemoral bypass graft operations performed on 77 patients from January 1978 to April 1990. Results: The mortality rate within 30 days of operation was 5% (four of 79); 36 patients died in the follow-up period; none died of graft causes. During this 12-year period (mean follow-up 42 months) three patients were unavailable for follow-up. The primary patency rate was 78% at 5 years and 73% at 7 years, with no change thereafter. Neither the graft configuration (i.e., axillounifemoral [n = 50] vs axillobffemoral [n = 29]) nor patency of the superficial femoral artery had an impact on the primary patency rate. Patients who underwent surgery for disabling claudication (n = 30 grafts) had a primary patency rate of 80% at 6 years compared with 65% at 6 years for those who required surgery for limb salvage (n = 49 grafts); the difference was not significant (p = 0.37). Actuarial survival of patients with axlllofemoral grafts was 23% at 10 years compared with 72% in a concurrent population of patients with aortofemoral bypass (p < 0.001). Conclusion: These findings indicate that axillofemoral bypass grafts may be appropriate for high-risk patients with severe aortoiliac disease who require revascularization for either limb salvage or incapacitating claudication. (J VAse Sire6 1993;17:107-15.) 108 El-Massry et al.