Axillofemoral bypass in poor risk patients with critical ischaemia.

While there is an abundance of information about the results of axillofemoral grafting in the North American literature there is little published data from this country. This may reflect a reluctance on the part of British surgeons to use the technique. In the years 1976-1981 we have performed 30 axillofemoral bypasses in 27 patients to alleviate critical ischaemia of the lower limb. Grafts were inserted to bypass aortoiliac occlusive disease in patients too old or too ill for an intra-abdominal operation. Thirty-three limbs were at risk of major amputation, 10 because of gangrene and 23 because of rest pain. Operative mortality was nil and complications were few. Only 38% of grafts remained patent for 2 years but results in terms of limb salvage were satisfactory. Only 3 major amputations were necessary and this confirms our view that the operation is a valuable alternative to intra-abdominal reconstruction in poor risk patients.