Axillo-popliteal bypass with sequential graft to femoral artery in a case of aorto-iliac occlusive disease with calcified abdominal aorta and iliac vessels (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.
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.
European Journal of Vascular Surgery, 1992
In a retrospective analysis 12 patients treated for aorto-femoral vascular infections between 1984 and 1990 were evaluated. They were all male with a mean age of 63 years. Indications for treatment were: mycotic aneurysms -3, primary aorto-enteric fistula -2 and graft infection -7. Surgical treatment consisted of implantation of an extra-anatomic bypass, carefully avoiding the infected area, followed by removal of the infected graft and tissue at the same session. There was no early mortality (<30 days) but the first year mortality was 42 % (n = 5). Causes of death were: aortic stump disruption (n = 1), recurrence of aorto-enteric fistula (n = 2), axillary anastomosis disruption (n = 1), cardiac failure (n = 1). Orthotopic reconstruction of the aorta after 12 months, as we advocate, was accomplished in two patients and is scheduled in another one. In two patients their poor condition precluded this second step, and in two further patients above-knee amputation with subsequent extra-anatomic graft removal was needed. Only one of the 12 extra-anatomic bypasses became infected. Reconstruction by axillo-femoraI bypass combined with removal of the aorto-femoral graft at the same session is a practicable procedure with good early results. However, the rate of successful orthotopic reconstruction of the aorta after 12 months is low because of a high mortality rate, especially in the presence of aorto-enteric fistulas, and because some patients with well functioning axillo-femoral grafts are in too poor condition for another large operation.
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...
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.
Axillofemoral Bypass for Critically Ischemic Lone Lower Limb A Mercy
2016
Critical limb ischemia with rest pain and/or tissue loss is a serious sequel of occlusive aortoiliac disease (AID) inevitably leading to amputation unless a timely successful revascularization is performed. The most effective therapy is aorto (bi) femoral bypass while endovascular intervention has an increasing role in lesions of favorable anatomy. However, there is a group of poor risk patients with co-morbidities who neither tolerate a major aortic surgery nor being suitable for endovascular therapy. For such patients, extra-anatomical bypass such as axillofemoral bypass, first used in 1963, emerges as an effective alternative. Herein, we describe the case of an Iraqi male, 65 year old with critically ischemic lone lower limb due to total occlusion of infra-renal aorta with a very poor distal runoff who underwent a successful axillofemoral bypass that relieved his pain and saved his single lower limb. The graft was patent 5 months following the operation as shown by Doppler ultrasonography (DUS) though longer follow up was not available. In conclusion, axillofemoral bypass is relatively a simple operation for a serious disease. Limb loss was inevitable in this patient without this " mercy trial.״ The alternative choice was either amputation or a major aortic surgery with a doubtful benefit and a definite morbidity.
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.
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.