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Extra-anatomical bypass grafting - a single surgeon's experience

Appleton, N.D., Bosanquet, David, Morris-Stiff, G, Ahmed, H, Sanjay, P and Lewis, M.H. 2010. Extra-anatomical bypass grafting - a single surgeon's experience. Annals of the Royal College of Surgeons of England 92 (6) , pp. 499-502. 10.1308/003588410X12664192076890

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Abstract

INTRODUCTION Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes. PATIENTS AND METHODS A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004. RESULTS Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery. CONCLUSIONS Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: Extra-anatomical bypass grafting ; Femoro-femoral ; Axillo-femoral ; Limb salvage
Publisher: Royal College of Surgeons of England
ISSN: 0035-8843
Last Modified: 04 Jun 2017 09:18
URI: http://orca.cf.ac.uk/id/eprint/93255

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