Comparison of axillounifemoral and axillobifemoral bypass operations

E. Ascer, F. J. Veith, S. K. Gupta, Larry A. Scher, R. H. Samson, S. A. White-Flores, Seymour Sprayregen

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Routine use of axillobifemoral (ABF) bypass has been advocated because this operation is thought to achieve better patency than the axillounifemoral (AUF) procedure. In 5 years we performed 34 AUF and 22 ABF bypass operations for limb salvage in high-risk patients using 6 mm polytetrafluoroethylene grafts. Five-year cumulative life table patency rates for AUF bypasses were 71% with reoperation (secondary patency) and 44% without reoperation (primary patency). These values were not significantly different (p > 0.5) from those for ABF bypasses (77% and 50%, respectively). Five-year limb salvage results (AUF 73%; ABF 89%) were also not significantly different (p > 0.1). Correlation of arterial outflow characteristics with graft patency revealed that 78% of the patients who never had graft occlusion had occluded superficial femoral arteries (SFA) demonstrated at the first operation, while 79% of the patients who experienced graft closure had comparable SFA occlusions. Our aggressive approach to graft thrombosis included angiographic study of the inflow arterial system. This revealed that 16% of the failed grafts were associated with hemodynamically significant stenosis of the donor subclavian artery. Our results indicate that AUF bypass is the procedure of choice for unilateral limb ischemia in high-risk patients who require an axillary source and that patency of the SFA does not affect outcome. These results also emphasize the need to obtain angiographic evaluation of the inflow system.

Original languageEnglish (US)
Pages (from-to)169-175
Number of pages7
JournalSurgery
Volume97
Issue number2
StatePublished - 1985
Externally publishedYes

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Transplants
Femoral Artery
Limb Salvage
Reoperation
Subclavian Steal Syndrome
Life Tables
Polytetrafluoroethylene
Thrombosis
Ischemia
Extremities
Tissue Donors

ASJC Scopus subject areas

  • Surgery

Cite this

Ascer, E., Veith, F. J., Gupta, S. K., Scher, L. A., Samson, R. H., White-Flores, S. A., & Sprayregen, S. (1985). Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery, 97(2), 169-175.

Comparison of axillounifemoral and axillobifemoral bypass operations. / Ascer, E.; Veith, F. J.; Gupta, S. K.; Scher, Larry A.; Samson, R. H.; White-Flores, S. A.; Sprayregen, Seymour.

In: Surgery, Vol. 97, No. 2, 1985, p. 169-175.

Research output: Contribution to journalArticle

Ascer, E, Veith, FJ, Gupta, SK, Scher, LA, Samson, RH, White-Flores, SA & Sprayregen, S 1985, 'Comparison of axillounifemoral and axillobifemoral bypass operations', Surgery, vol. 97, no. 2, pp. 169-175.
Ascer E, Veith FJ, Gupta SK, Scher LA, Samson RH, White-Flores SA et al. Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery. 1985;97(2):169-175.
Ascer, E. ; Veith, F. J. ; Gupta, S. K. ; Scher, Larry A. ; Samson, R. H. ; White-Flores, S. A. ; Sprayregen, Seymour. / Comparison of axillounifemoral and axillobifemoral bypass operations. In: Surgery. 1985 ; Vol. 97, No. 2. pp. 169-175.
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