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November 1979

Late Results of Extra-anatomic Bypass

Author Affiliations

From the Division of Vascular Surgery (Drs Machleder, Livesay, Atkinson, Busuttil), UCLA School of Medicine, Los Angeles; and the Surgical Service (Drs Barker, Baker), Veterans Administration Medical Center, Sepulveda, Calif.

Arch Surg. 1979;114(11):1260-1267. doi:10.1001/archsurg.1979.01370350062006

• Clinical progress and results were reviewed in 100 consecutive patients who underwent extra-anatomic bypass procedures for brachiocephalic and aortoiliac occlusive disease during the past 15 years. Of 113 procedures in this group, extra-anatomic bypass of the brachiocephalic vessels, axillo-femoral bypass, and femorofemoral bypass were performed. Although these procedures were performed in high-risk patients to avoid intrathoracic and intra-abdominal reconstruction or to circumvent undesirable anatomic areas, a low operative mortality was achieved. Symptomatic improvement, augmented Doppler ankle pressure index, and high limb-salvage rate were noted. Life-table analysis has confirmed prolonged five-year graft patency. The suspected high-risk characteristic in this group was corroborated by high progressive mortality observed particularly after axillo-femoral bypass and was due primarily to the severity of associated diseases. Analysis of the late results of extraanatomic bypass confirms the safety and effectiveness of this procedure in poor-risk patients.

(Arch Surg 114:1260-1267, 1979)