Axillary-Femoral Bypass May Provide Inadequate Distal Perfusion Compared with In-Line Large Diameter Aortic Reconstruction

Axillary-femoral bypass is sometimes performed for complex aortoiliac occlusive disease in patients unfit for aortic surgery or in those with aortic infection. Typically, older patients with medical comorbidities that commonly accompany atherosclerotic or aneurysmal disease are involved and can tolerate the theoretic risk of limited flow volume associated with long, small diameter, axillary-femoral grafts. However, a subset of younger, healthier, more vigorous patients outside the typical atherosclerotic or aneurysmal demographic occasionally come to axillary-femoral bypass and may experience symptoms of distal hypoperfusion if flow volumes cannot meet demand. We present a series of patients with primary aortic infection treated with aortic ligation and axillary-femoral bypass, who then progressed to symptoms of visceral, spinal, or extremity ischemia from inadequate distal perfusion.