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The Journal of Cardiovascular Surgery 2000 December;41(6):905-10

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Multivariate analysis of long-term results after an axillo-bifemoral and aortobifemoral bypass in patients with aortoiliac occlusive disease

Onohara T., Komori K., Kume M., Ishida M., Ohta S., Takeuchi K., Matsumoto T., Sugimachi K.

From the Department of Surgery II, Faculty of Medicine Kyushu University, Fukuoka, Japan


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Background. Controversy ­still ­remains regard­ing the ­long-­term ­results and indi­ca­tions for axil­lof­e­mo­ral ­bypass (AxFB). A com­par­i­son of axil­lo­bif­e­mo­ral ­bypass (AxBFB) and aor­to­bif­e­mo­ral ­bypass (­ABFB) was ­thus con­duct­ed to deter­mine wheth­er AxFB is an accept­able alter­na­tive vas­cu­lar pro­ce­dure to ana­tom­ic ­bypass for ­high-­risk ­patients.
Methods. Sixty-­three ­patients who under­went a ­total of 25 AxBFBs and 38 ABFBs for aor­toi­liac occlu­sive dis­ease ­were ­reviewed ret­ro­spec­tive­ly, and ­both uni­var­i­ate and mul­ti­var­ate anal­y­ses ­were per­fomed.
Results. The over­all sur­vi­val was 82.8% at ­five ­years. A uni­var­i­ate anal­y­sis ­revealed sig­nif­i­cant­ly low­er sur­vi­val ­rates for ­patients ­with ­limb-threat­en­ing ische­mia, cor­o­nary dis­ease, and cereb­ro­vas­cu­lar dis­ease. A mul­ti­var­i­ate anal­y­sis dis­closed no sig­nif­i­cant fac­tors influ­enc­ing sur­vi­val ­rates. The over­all pri­mary paten­cy was 79.8% at ­five ­years. The pri­mary paten­cy ­rates for AxBFB (67.7% at ­five ­years) ­were sig­nif­i­cant­ly low­er ­than for ­ABFB (88.5% at ­five ­years) ­based on a uni­var­i­ate anal­y­sis (p=0.0045). In addi­tion, the sec­on­dary paten­cy ­rates for AxBFB (80.3% at ­five ­years) ­were sig­nif­i­cant­ly low­er ­than for ­ABFB (96.5% at ­five ­years, p=0.0025). A mul­ti­var­i­ate anal­y­sis dis­closed sig­nif­i­cant­ly low­er pri­mary paten­cy ­rates for ­grafts ­with a high­er angio­graph­ic out­flow ­score and simul­ta­ne­ous infra­ing­ui­nal recon­struc­tive pro­ce­dures, but the dif­fer­enc­es ­between AxBFB and ­ABFB ­were not sig­nif­i­cant.
Conclusions. The sur­vi­val and pri­mary paten­cy for the AxBFB ­group ­were ­both infe­ri­or to the ­ABFB ­group, how­ev­er a mul­ti­var­ate anal­y­sis dis­closed no sig­nif­i­cant dif­fer­enc­es ­between the two ­groups. Poor femo­ral run-off and the pres­ence of syn­chro­nous infra­in­gui­nal recon­struc­tive pro­ce­dures sig­nif­i­cant­ly affect­ed ­graft paten­cy, and ­these fac­tors mod­ulat­ed the paten­cy of AxBFB. AxFB for aor­toi­liac occlu­sive dis­ease is there­fore con­sid­ered to be an accept­able pro­ce­dure in appro­pri­ate­ly select­ed ­patients.

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