Improved patency after axillofemoral bypass for aortoiliac occlusive disease

Abstract

Our data indicate that AxBFB and AxUFB performed with the use of modern protocols and technology may render them an acceptable valid primary intervention in patients in whom endovascular treatment has failed or is unlikely to offer long-term success. The simplicity of performing these grafts and their low mortality and morbidity lend their application to surgeons with limited open aortic experience. Because AxUFB and AxBFB have similar patency rates, AxBFB should be reserved for bilateral indications.

The Comparison between Axillofemoral Bypass and Endovascular Treatment for Patients with Challenging Aortoiliac Occlusive Disease as Alternative Treatment to Aortofemoral Bypass

“…For AxFB surgeries, we used the externally supported 10-mm-diameter main limb of a Dacron graft with 8-mm-diameter externally supported bilateral femoral components of a Dacron graft. However, Samson et al 7) reported that they implanted ring-reinforced 8-mm-diameter expanded polytetrafluoroethylene (ePTFE) grafts with or without heparin bonding. They found that these materials contributed to better outcomes, including better graft patency rates.…”

“…13) However, no report has compared the graft patency rates between heparin-bonded and non-heparin-bonded ePTFE grafts in AxFB. Furthermore, Samson et al 7) reported that 2 of 34 (5.9%) non-heparin-bonded ePTFE grafts and 3 of 42 (7.1%) heparin-bonded ePTFE grafts were thrombosed; therefore, they concluded that they could not demonstrate the superiority of heparin-bonded ePTFE grafts for AxFB. Based on these comparisons (Dacron vs. ePTFE, extra-supported vs. non-supported, and heparin-bonded vs. non-heparin-bonded), some materials might affect patency rates in AxFB grafting, though not always positively.…”

“…6) We have treated patients with complex AIOD who had severe comorbidities using AxFB or EVT to prevent post-operative complications. Recently, Samson et al 7) reported a high primary patency rate in patients treated by AxFB (83.7% at 5 years), representing what are to our knowledge the best results of AxFB treatments to date.…”

Combined Coronary Artery Bypass Grafting and Extra-anatomic Ascending Aorta to Bifemoral Grafting Through Median Sternotomy

“…Patients often present with severe systemic atherosclerotic disease with the involvement of the coronary and aortoiliac arteries [8,9]. With symptomatic occlusion of these systems, extraanatomic bypass grafting for aortoiliac disease is an indicated and reliable surgical option [10][11][12][13]. In these select patients, the goals of preoperative planning should aim to combine interventions into one operation, avoid opening the abdominal cavity, and improve peri-and postoperative graft patency.…”

“…Evidence supports the use of aortobifemoral over axillobifemoral grafting when feasible, as both the primary and secondary patency rates are lower in axillobifemoral grafting [13][14][15]. The ascending aorta is already exposed in the surgical field and provides a higher flow rate [10]. Furthermore, with bilateral subclavian artery ostial stenosis, as in our patient, the axillary artery is an even less favorable graft option; it also excludes the left mammary artery as a conduit for the CABG.…”