Alternative procedures to aortobifemoral bypass grafting.

The outcome of 175 bypass procedures performed on 174 patients with symptomatic aortoiliac occlusive disease during a five-year period were analyzed. Fifty-nine patients underwent a standard aortofemoral bypass and 116 patients underwent one of three alternative procedures consisting of femoro-femoral, iliofemoral, or axillofemoral bypass. The operative stress, morbidity, mortality and long-term results were compared. Although the aortofemoral group had a higher three-year cumulative patency rate (89% vs 81%), the alternative procedure group had a lower operative mortality (1.8% vs 7%). In addition, the patients in the alternative procedure group were slightly older, had a higher percentage of procedures performed for limb salvage, and had a less optimal run-off status, yet the complication rate was significantly less than that of the aortofemoral group (p less than 0.05). The use of these alternative procedures should be considered for patients with symptomatic aortoiliac disease, who represent a moderate operative risk as well as those in a high risk category.