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James J. Livesay, MD; James B. Atkinson, MD; J. Dennis Baker, MD; Ronald W. Busuttil, MD, PhD; Wiley F. Barker, MD; Herbert I. Machleder, MD

Arch Surg. 1979;114(11):1260-1267.

Abstract
• 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)

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.

Footnotes
Accepted for publication July 23, 1979.

Read before the 27th scientific meeting of the International Cardiovascular Society, Nashville, Tenn, June 28, 1979.

Reprint requests to Department of Surgery, 72-182A, UCLA School of Medicine, Los Angeles, CA 90024 (Dr Machleder).

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