Abstract
The purpose of this study was to review our results with axillofemoral by-passes performed for aortoiliac occlusive disease. Fifty patients receiving 51 axillofemoral by-passes from January 1989 to December 1994 were retrospectively reviewed. The 30-day post-operative mortality was 4%. Seven patients (14%) presented graft-related local complications and all but one required reoperation. Five patients were lost to follow-up, the mean length of which was 36 months (16–74 months). Forty-nine per cent of the patients died during the follow-up period. At 36 months, the primary patency rate was 51%, the secondary patency rate was 69%, and limb valvage rate was 87%. A statistical difference was seen in the secondary patency rate between axillobifemoral by-pass (87%) and axillo-unifemoral by-pass (56%) at 36 months (P<0.01), but no difference was seen in the limb salvage rate at 36 months between the two configurations of the by-pass (94% vs 81 %) (P=NS). Twenty patients (40%) operated upon for acute ischemia had a significantly higher post-operative mortality rate (10% vs 0), a significantly higher amputation rate (20% vs 6.6%) and a significantly lower patency rate of by-pass (26% vs 63%) (P<0.01), than the 30 patients (60%) operated on for claudication, rest pain or trophic ulcers. Our findings indicate that the results of axillofemoral by-pass are significantly influenced by the selection of patients for operation, namely the clinical status of ischaemic symptoms, and that since the overall results of axillofemoral by-pass are inferior to those of aortofemoral by-pass, this treatment should be restricted to patients at high risk of aortic clamping.
Zusammenfassung
Es wurden 51 axillofemorale By-passoperationen aus dem Zeitraum Januar 1989 bis Dezember 1994 retrospektiv analysiert. Die postoperative Mortalitätsrate (nach 30 Tagen) betrug 4%. Bei 7 Patienten (14%) traten am Graft Komplikationen ein, so daß 6 von ihnen reoperiert werden mußten. In die Nachuntersuchung (mittleres Follow-up: 36 Monate, Spanne: 16–74 Monate) konnten 5 Patienten nicht einbezogen werden. Während der Follow-up-Periode verstarben 49% der Patienten. Nach 36 Monaten betrug die primäre Durchflußwiederherstellungsrate 51%, die sekundäre 69%, die Sanierungsrate im betroffenen Glied 87%. Statistisch gab es nach 36 Monaten bei der sekundären Durchflußwiederherstellungsrate einen Unterschied zwischen axillo-bifemoralen (87%) und axillo-uni-femoralem Bypass (56%) (p<0,01), aber hinsichtlich der Heilungsrate gab es zu diesem Zeitpunkt zwischen den beiden Bypass-Arten keinen signifikanten Unterschied (94% vs. 81%). Die postoperative Mortalitätsrate war bei 20 Patienten (40%), die wegen akuter Ischämie operiert worden waren, signifikant höher (10% vs. 0%); ebenso die Amputationsrate (20% vs. 6,6%); signifikant niedriger hingegen war die Durchflußwiederherstellungsrate nach Bypass (26% vs. 63%) (p<0,01) —im Vergleich zu 30 Patienten (60%), die wegen Claudicatio, Ruheschmerz oder trophischen Ulzera operiert worden waren. Nach unseren Untersuchungen sind die Ergebnisse bei axillofemoralen Bypassoperationen entscheidend abhängig von der Auswahl der Patienten gemäß klinischem Zustand und ischämischen Symptomen. Die Gesamtergebnisse nach axillofemoralem Bypass sind schlechter als nach aortofemoralem Bypass, und darum sollte die erstgenannte Operation nur bei Patienten angewendet werden, bei denen die Abklemmung der Aorta ein hohes Risiko darstellen würde.
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Illuminati, G., Calio, F.G., Mangialardi, N. et al. Results of axillofemoral by-passes for aorto-iliac occlusive disease. Langenbecks Arch Chiv 381, 212–217 (1996). https://doi.org/10.1007/BF00571687
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DOI: https://doi.org/10.1007/BF00571687