Axillary-popliteal artery bypass provides successful limb salvage after removal of infected aortofemoral grafts

W. J. McCarthy, G. S. McGee, W. W. Lin, W. H. Pearce, W. R. Flinn and J. S. Yao
Department of Surgery, Northwestern University Medical School, Chicago, Ill.

Axillary-popliteal artery bypasses were placed to revascularize 28 extremities for 17 patients who were undergoing removal of infected aortofemoral grafts. Polytetrafluoroethylene (PTFE [polytef]) material was anastomosed to the above-knee popliteal artery in 22 cases and to the below-knee popliteal artery in six limbs. All but one patient had axillary-popliteal grafts in place before excision of the aortic graft. In 12 groins, vein-patch angioplasty was performed after removal of the infected aortic graft to provide retrograde pelvic perfusion and maintain femoral patency for future reconstruction. Three patients (18%) died of septic-related, multisystem organ failure. With a mean follow-up of 25 months, primary patency was 75% at 1 year and 43% at 2 years. Secondary patency, maintained by thrombectomy (n = 7), revision (n = 3), and conversion to warfarin sodium (Coumadin) therapy (n = 6) was 100% at 2 years, and limb salvage was achieved for all surviving patients.