Extra-anatomical bypass (EAB) is selected as an alternative for anatomical bypass (AB) in the treatment of chronic arterial occlusive disease, when AB is inappropriate because of age, history of abdominal surgery or other high risks.
From 1989 to 2005, we experienced 91 surgical reconstructions for chronic arterial occlusive disease. EAB was performed in 36cases (39.6%) (axillo-femoral bypass 18 cases and femoro-femoral crossover bypass 18 cases). The patient age ranged from 52 to 82 years old, and the mean age was 70 years old, male-female ratio being 32 : 4. Duration of operation and hospitalization, graft patency, and postoperative complications were compared between EAB-group and AB-group. Indication of EAB was severe calcification of the aorta, history of previous laparotomy, high age or other high risks. Postoperative evaluation was performed by magnetic resonance angiography, ankle brachial arterial pressure index and other examinations. In the EAB group, there was no major postoperative complications or operative deaths except a few regional lymphorrhoea and subcutaneous hematoma.
Primary and secondary 3-year patency rates were 88.2% and 94.4% in femoro-femoral bypass, and 88.9% and 94.1% in axillo-femoral bypass respectively. Late deaths were observed in 3 patients in axillo-femoral bypass and 2 patients in femore-femoral bypass (5 in total), but no relation was suspected to EAB.
In conclusion, we consider that EAB is an effective alternative for patients with high age and other high risks guaranteeing better quality of life.