Extra-anatomic bypass shunting in aorto-iliac occlusive disease. Clinical results and risk factors in a Belgian population.

Abstract

We present a retrospective study of 38 patients undergoing axillofemoral bypass shunting (AXF, n=42, including 29 axillobifemoral (AXBF) and 9 axillo-unifemoral (AXUF)) from 1988 to 1998, for aorto-iliac occlusive disease (AOD). Six were excluded from the study as they did not meet entry criteria; the remaining 32 patients were retained. All patients had histories of failed medical treatment. Indications for grafting were limb salvage (n=19), pain at rest (n=10), and high grade claudication (n=9). There were 28 males. Mean age was 73 years (range: 56-86). Preoperative assessment, risk factors and early outcome were considered. Knitted Dacron and Gore-Tex prostheses were used. Indications for AXF was poor general status, locally hostile or septic abdomen. All the patients were symptom-free early after surgery, with disappearance of pain at rest, improvement in trophic necrotic, and gangrenous lesions of the limbs, and better independence in walking ability. One patient died during the first 30 days (3% operative mortality). Most deaths occurred within 6 months due to causes unrelated to surgery, mainly in patients with comorbid conditions. AXF bypass is an acceptable procedure for high risk AOD patients or when conventional anatomic in situ repair is contraindicated.