Repeat axillofemoral grafting as treatment for axillofemoral graft occlusion

Christine J. Olson, James M. Edwards, Lloyd M. Taylor, Gregory J. Landry, Richard A. Yeager, Gregory L. Moneta, E. John Harris, Samuel Eric Wilson, Stephen N. Etheredge, F. William Blaisdell, Fred A. Weaver, G. Andrew Macbeth, Albert D. Hall, James J. Peck

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    4 Scopus citations

    Abstract

    Background: Patency of failed axillofemoral (ax-fem) grafts following thrombectomy is so poor, aortofemoral grafts are recommended as treatment for ax-fem graft thrombosis. In patients who are not candidates for aortic grafting, repeat ax-fem grafting is an alternative to thrombectomy. This report compares our experience treating ax-fem graft thrombosis with replacement or revision vs thrombectomy. Methods: Patients treated with ax-fem grafts from October 1985 to April 2001 were identified, and those who underwent reoperation for thrombosis were reviewed. Limb salvage and patency of revision procedures (thrombectomy vs repeat ax-fem grafting) were determined using Kaplan-Meier curves. Results: Three hundred thirty-five patients underwent ax-fem grafting, and 39 (11.6%) of the 335 required reoperation for graft failure. Twenty-five of these 39 patients had 51 operations for graft thrombosis: 42 graft replacements and/or anastomotic revision(s), and 9 thrombectomies. At 18 months, mean ± SD patency following thrombectomy was 11% ± 10%, while that for graft replacement or anastomotic revision was 54% ± 8% (P<.001). Limb salvage at 18 months following revision for thrombosis was 88% ± 5%. Conclusions: The large majority of ax-fem grafts do not require reoperation. For failure due to thrombosis, repeat ax-fem grafting provides excellent limb salvage. Axillofemoral graft replacement and/or anastomotic revision has superior patency to thrombectomy.

    Original languageEnglish (US)
    Pages (from-to)1364-1368
    Number of pages5
    JournalArchives of Surgery
    Volume137
    Issue number12
    DOIs
    StatePublished - Dec 1 2002

    ASJC Scopus subject areas

    • Surgery

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  • Cite this

    Olson, C. J., Edwards, J. M., Taylor, L. M., Landry, G. J., Yeager, R. A., Moneta, G. L., Harris, E. J., Eric Wilson, S., Etheredge, S. N., William Blaisdell, F., Weaver, F. A., Andrew Macbeth, G., Hall, A. D., & Peck, J. J. (2002). Repeat axillofemoral grafting as treatment for axillofemoral graft occlusion. Archives of Surgery, 137(12), 1364-1368. https://doi.org/10.1001/archsurg.137.12.1364