The Axillary-Bi-Profunda Femoris Artery Bypass is Linked to a Higher Long-Term Risk of Amputation Compared to the Axillary-Bi-Common Femoral Artery Bypass.

Abstract

Objective: Axillofemoral bypass to treat aortoiliac occlusive disease is an extra-anatomic bypass which is an alternative to aortobifemoral bypass in patients deemed to be unfit to undergo an aortic operation. Distal anastomosis is usually sewn to the common femoral artery. However, in patients with occluded common femoral and superficial femoral arteries, profunda femoris artery can be used as the outflow. This study compares the outcomes of axillary to bilateral common femoral (Ax-Bi-CFA) and axillary to bilateral profunda femoris artery (Ax-Bi-PFA) bypasses.

Methods: 1,358 patients were included in the study from VQI registry data (1,194 patients: axillary to bilateral common femoral artery (Ax-Bi-CFA) bypass and 164 patients: axillary to bilateral profunda femoral artery (Ax-Bi-PFA) bypass). The primary outcomes studied were minor and major amputation as well as mortality at 30-days and at 1-year follow up. A p-value <0.05 was considered statistically significant across all analyses. Significant variables from the univariate analysis were further evaluated using multivariate logistic regression. Ax-Bi-CFA bypass was considered the reference group for the multivariable models.

Results: Male patients were more likely to undergo an Ax-Bi-PFA bypass (n=106, 64.63%) compared to female patients (n=58, 35.37%). Patients with history of hypertension (n=152, 92.68%), CABG/PCI (n=67, 44.97%), prior arterial bypass (n=49, 29.88%), and prior history of smoking (n=80, 49.08%) were more likely to undergo an Ax-Bi-PFA bypass (p<0.05). Univariate analysis showed that patients with Ax-Bi-PFA bypass had relatively higher risk of major amputation at 30-days (9.76% in Ax-Bi-PFA vs. 4.36% in Ax-Bi-CFA, p=0.003) and at 1-year follow-up compared to patients who underwent Ax-Bi-CFA bypass (15.9% in Ax-Bi-PFA vs. 6% in Ax-Bi-CFA, p<0.05). There was no significant difference in mortality. On multivariate logistic regression, Ax-Bi-PFA bypass had a significantly higher risk of major amputation compared to patients who underwent Ax-Bi-CFA bypass at 1-year follow up (OR 2.44, 95% CI 1.39-4.28, p<0.05). There was no statistically significant difference observed at the 1-year time-endpoint (p=0.09).

Conclusion: Patients with Ax-Bi-PFA bypass have increased risk of major amputation at 30-day and at 1-year follow up compared to patients with Ax-Bi-CFA bypass. After the risk adjustment, the odds of major amputation were observed to be significantly higher for Ax-Bi-PFA bypass as compared to patients in the other group.