Our Summary

This research paper investigates the role of a specific surgical procedure called axillofemoral bypass in the treatment of aortoiliac disease, a condition affecting the large blood vessels that branch out from the aorta, the main blood vessel in the body. The researchers reviewed all such procedures performed at their institution between 2006 and 2013, comparing data with a previous study conducted before the widespread use of less invasive techniques, known as endovascular techniques.

They found that the number of bypass operations had almost halved, from an average of 24 per year to just 12. The reasons for performing the procedure also changed, with more operations now being carried out as urgent or emergency procedures. The research found that at one and two years after surgery, the bypass was still functional in around 75% and 68% of patients, respectively. The median survival time post-surgery was just over 40 months, with overall survival rates at one and two years being roughly 67% and 54%, respectively.

The study concludes that axillofemoral bypass surgery is becoming less common and is more likely to be used as a last resort to save a limb in urgent or emergency situations.

FAQs

  1. What is the role of axillofemoral bypass in contemporary practice?
  2. How has the use and indications for axillofemoral bypass changed with the advent of endovascular techniques?
  3. What is the overall survival rate and patency for axillofemoral bypass procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vascular bypass is to follow a healthy lifestyle, including regular exercise, a balanced diet, and not smoking, to help improve the long-term success of the bypass procedure. It is also important to follow up with regular appointments with your healthcare provider to monitor the patency of the bypass and address any potential issues early on.

Suitable For

Patients who are typically recommended for vascular bypass procedures, such as axillofemoral bypass, are those with aortoiliac disease who are not suitable candidates for endovascular approaches. These patients may have severe peripheral arterial disease and require limb salvage in urgent or emergent settings. The decision to perform a vascular bypass procedure is based on the extent and severity of the arterial disease, as well as the patient’s overall health and comorbidities. In some cases, a vascular bypass may be recommended as a more durable and effective treatment option compared to endovascular techniques.

Timeline

Before vascular bypass:

  1. Patient presents with symptoms of peripheral arterial disease, such as leg pain, numbness, or weakness.
  2. Patient undergoes diagnostic tests, such as ultrasound or angiography, to determine the extent of the blockage in the arteries.
  3. Patient may undergo conservative treatment, such as lifestyle changes or medication, to improve blood flow.
  4. If conservative treatment is ineffective, patient may be recommended for a vascular bypass surgery.

After vascular bypass:

  1. Patient undergoes axillofemoral bypass surgery to reroute blood flow around the blocked artery.
  2. Patient is monitored closely in the hospital for any complications or signs of infection.
  3. Patient undergoes rehabilitation to regain strength and mobility in the affected limb.
  4. Follow-up appointments are scheduled to monitor the patency of the bypass and overall health of the patient.
  5. Patient may experience improved blood flow and relief of symptoms, such as pain and numbness, in the affected limb.

What to Ask Your Doctor

  1. What are the specific reasons for recommending a vascular bypass procedure in my case?
  2. What are the potential risks and complications associated with the axillofemoral bypass procedure?
  3. How long can I expect the recovery process to take, and what can I do to help facilitate a successful recovery?
  4. What type of follow-up care will be necessary after the procedure, and how often will I need to come in for check-ups?
  5. What are the expected outcomes of the axillofemoral bypass in terms of improved blood flow and symptom relief?
  6. Are there any alternative treatment options available for my condition, and how do they compare to the vascular bypass surgery?
  7. How experienced is the surgical team in performing axillofemoral bypass procedures, and what is the success rate at this institution?
  8. Are there any lifestyle changes or medications that I will need to implement or continue after the bypass surgery to maintain optimal vascular health?
  9. What signs or symptoms should I watch for after the procedure that may indicate complications or the need for medical attention?
  10. Are there any specific questions or concerns that I should discuss with a vascular surgeon before proceeding with the axillofemoral bypass surgery?

Reference

Authors: Nguyen KP, Perrone KH, Rahman A, Azarbal AF, Liem TK, Mitchell EL, Moneta GL, Landry GJ. Journal: Am J Surg. 2016 May;211(5):968-71. doi: 10.1016/j.amjsurg.2016.02.003. Epub 2016 Feb 26. PMID: 27046796