Axillobifemoral Bypass

What is axillobifemoral bypass?

Axillobifemoral Bypass

The aorta is a major artery that supplies oxygenated blood from the heart to all the parts of your body. It splits into the iliac arteries just near the navel. These arteries run beyond the groin region to form the femoral arteries which supply blood to the legs. Atherosclerosis or plaque (cholesterol or calcium) deposition on the inner wall of the aorta or iliac arteries can obstruct the blood flow (due to narrowing of the arteries) leading to symptoms such as muscle cramps, difficulty in walking long distances, foot ulcers and gangrene. This condition can be treated surgically by a procedure called axillobifemoral bypass to restore proper blood flow to your legs.

The surgery involves bypassing the blocked arteries of the abdomen and rerouting the blood by connecting your axillary artery (present in your shoulder) to the femoral artery in your groin. The axillary artery is a blood vessel that carries oxygen-rich blood to the upper parts of the body such as the thorax, upper limb and armpit.

What are the indications and contraindications for axillobifemoral bypass?

The axillobifemoral bypass is indicated for the treatment of the following conditions:

  • Lower extremity ischemia: restricted blood supply to legs
  • Aortoenteric fistulae: abnormal connection between aorta and digestive tract
  • Aortic coarctation: birth defect characterized by the narrowing of the aorta
  • Patients who do not have the option of endovascular surgery for ischemia
  • High-risk patients with other disorders that could interfere with the correction of atherosclerosis from within the artery
  • Infected aortic grafts: artificial material inserted to replace diseased aortic tissue

The contraindications include:

  • Abnormality in the subclavian (arteries of the upper chest) and axillary arteries

How is axillobifemoral bypass performed?

Before the surgery, your doctor may order imaging tests (CT angiography or magnetic resonance angiography) to assess blood vessels in the lower extremities and locate the blockage.

The surgery is carried out under general anesthesia. Your surgeon makes a small incision on your chest region, next to your shoulder and two incisions at each groin region. A tunnel is created under the surface of the skin from your shoulder, down the side of your chest and abdomen, to reach your groin area. An artificial graft is prepared and channeled through this tunnel. Another tunnel is created under the surface of the skin, between the two femoral arteries (femoral to femoral tunnel) just above the pubic bone. This is referred to as bifemoral reconstruction.

A graft is passed through this tunnel carefully (avoiding twists or kinks). A longitudinal incision is made in the wall of the axillary artery, and one end of the graft is sutured to the opening in the artery. Similarly, the other graft is sutured to the two femoral arteries. Next, your surgeon connects the end of the axillary graft to the femoral graft. Following this, the 3 incisions are closed with sutures.

What can you expect after axillobifemoral bypass?

After the surgery, you will be monitored to ensure that the graft is working fine. You will be discharged from the hospital after you recover completely 2-5 days after surgery.

Are there any complications of axillobifemoral bypass?

As with all surgical procedures, axillobifemoral bypass procedure may be associated with certain risks such as but are not limited to:

  • Infection or blockage of the grafts
  • Bleeding
  • Formation of blood clot in leg artery (deep vein thrombosis) or graft (graft thrombosis)
  • Nerve injury
  • Death

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