The role of axillofemoral bypass in current vascular surgery practice

Background In the era of increasing endovascular approaches for aortoiliac disease, we sought to determine the role of axillofemoral bypass in contemporary practice. Methods All axillofemoral bypasses performed at our institution from 2006 to 2013 were reviewed for indication, patency, and survival and compared with our prior published series before the widespread use of endovascular techniques (1996 to 2001). Results During the study period, 90 bypasses (29 axillofemoral and 61 axillobifemoral) bypasses were performed. The number of procedures performed decreased from an average of 24 to 12 procedures per year in historical and contemporary groups, respectively. Indications have changed significantly with more urgent or emergent procedures. Overall patency at 1 and 2 years was 74.6% and 67.8%, respectively. Median survival was 40.3 months, with overall survival 67.0% and 54.2% at 1 and 2 years, respectively. Conclusions Axillofemoral bypass is an increasingly uncommon procedure and more likely performed for limb salvage in urgent or emergent settings.