Comparison and Short-term Outcomes in patients undergoing Axillobifemoral and Axillounifemoral Bypass Graft
Goran Tesic, MD, Arthelma C. Tyson, MD, Saqib Zia, MBBS, Jonathan A. Schor, MD, Jonathan S. Deitch, MD, Kuldeep Singh, MD.
Staten Island University Hospital, New York, NY, USA.
OBJECTIVE: Axillofemoral bypass is traditionally used as an alternative for aortoiliac occlusive disease. Typically, axillobifemoral bypass is used as the procedure of choice, however a comparison of axillounifemoral (AUFB) and axillobifemoral bypass (ABFB) is not well studied.
METHOD: We queried the NSQIP database for all patients that underwent axillounifemoral (CPT 35521) and axillobifemoral bypass (CPT 35654) performed between 2005 and 2011. We reviewed demographics, co-morbidities and 30 day outcomes. We excluded all emergency cases and all cases performed with a venous conduit. Patient demographics, co-morbidities, smoking, graft failures, blood transfusions, steroid use, wound infections, failure to wean, myocardial infarction and mortality were compared between groups using chi-square and t-test as appropriate.
RESULTS: A total of 595 patients underwent axillobifemoral bypass and 96 patients in the axillounifemoral bypass group. Patients in axillounifemoral group mean age was 68 versus 66 in the axillobifemoral group. 60 (62.5%) male patients and 36 (27.5%) female patients were recorded in the axillounifemoral group, while 283 (47.5%) male and 312 (52.5%) female patients comprised the axillobifemoral group. Primary outcomes examined were 30-day graft failure and wound infection. There is a significant difference (p=0.01) in short term graft failure comparing axillobifemoral bypass (2.6%) and axillounifemoral bypass (9.1%). A significant difference (p=0.03) was also found when comparing the two groups in terms of wound infection occurrences within 30-days, axillobifemoral (33.1%) and axillounifemoral (55%). We also assessed risk factors and perioperative occurrences such as smoking (ABFB 54% vs. AUFB 34% p<0.05), diabetes (ABFB 25% vs. AUFB 29% p=0.38), blood transfusion (AUFB 0% vs. ABFB 2.2% p=0.23), failure to wean from ventilation (AUFB 3.1% vs. 8.4%, p=0.09), myocardial infarction (AUFB 2.1% vs. ABFB 2.7%, p=1.0), acute renal failure (AUFB 1% vs. ABFB 0.2% p=0.26), steroid use (AUFB 5.2% vs. ABFB 3.9% p=0.57) and mortality (AUFB 3.1% vs. ABFB 8.5% p+0.07).
CONCLUSION: We noted a significant difference between axillounifemoral and axillobifemoral bypass short- term outcomes with regards to graft failure and wound infection. Results are favoring axillobifemoral bypass, despite increased complexity of the procedure and additional incisions which would favor risk of wound infection. Further studies are needed to elucidate causality and dynamics which apply.
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