[The axillofemoral bypass as an aortoiliac principle of reconstruction in high risk patients. Long term results from 1970-1979 (author's transl)].

A total of 95 consecutive high-risk patients (average age of 68.28 years) underwent 114 axillofemoral bypass operations for revascularization of 116 lower extremities (1970-1979); 84.48% were in stage III and IV. Four bypass variations were used: unilateral bypass (70.8%), crossing bypass (4.4%), bilateral procedure (10.6%) and axillobifemoral bypass (14.2%). In elective operations, the operative mortality was 6.3%; in emergency operations one of 3 patients died. The unilateral bypass including the 5 patients on whom the crossing bypass was used showed a cumulative 5-year patency rate of 51.60%; the bifemoral bypass had a rate of 77.14% and in cases of bilateral bypass no graft was patent after 5 years. Graft thrombosis was the most common complication (47.37%); successful revision was possible in only 53.75%. In case of bifemoral procedure, graft thrombosis occurred in only 29.41%. Therefore, the authors recommend that stricter indications be employed for surgery: an axillofemoral bypass operation should only be performed in cases in stage III and IV for limb salvage and only in a "real" high-risk patient. In addition, the axillobifemoral variation should also be preferred in all cases of bilateral occlusive disease with unilateral symptomatology.