THE POOR-RISK patient with ischemia of the lower extremities secondary to aortoiliac occlusive disease represents a major problem in surgical management. Reconstructive arterial surgery, to be effective, must re-establish an adequate pulsatile blood flow at least to the level of a patent profunda femoris artery. Ideally, a direct antioplastic procedure, either synthetic graft replacement bypass or endarterectomy, will, in the majority of instances, provide a satisfactory outcome. However, there is a small group of patients in whom an intra-abdominal procedure of the above proportions would be associated with a prohibitive risk.
Recently several encouraging reports have appeared in the literature describing methods whereby the subclavian-axillary axis is utilized as the proximal source of blood flow to revascularize the lower extremity.1,2,3
It is the purpose of this paper to discuss our experiences with the axillary-femoral artery bypass as an elective and definitive means of salvaging the ischemic extremity in the