1. Axillary-Bi-Femoral and Axillary-Uni-Femoral Artery Grafts Have Similar Perioperative
Outcomes and Patency
Thomas W. Cheng1, M.S., Scott Hardouin1, M.D., Alik Farber1, M.D., Jeffrey A. Kalish1, M.D., Douglas W. Jones1, M.D., Mahmoud B. Malas2, M.D., Denis Rybin1, Ph.D., Brad S. Oriel1, M.D., Lenee M. Plauche1, M.D., Jeffrey J. Siracuse1, M.D.
1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA.
2Division of Vascular and Endovascular Surgery, University of California San Diego, School of Medicine, La Jolla, CA.

2. Disclosures
None

3. Background
Aortoiliac occlusive disease is a common cause of lower extremity ischemia
Aortobifemoral bypass remains the “gold standard”
Historically, axillobifemoral bypass have superior patency compared to axillounifemoral bypass
More recent small single-center studies showed comparable results between the two bypass configurations

4. Objective
To assess contemporary outcomes of axillounifemoral and axillobifemoral bypasses

5. Methods Vascular Quality Initiative
2010 to 2017 for all axillounifemoral and axillobifemoral bypass
Indication included claudication, rest pain, and tissue loss
Acute limb ischemia excluded
Baseline characteristics, procedure details, and outcomes were collected
Univariable and multivariable analyses were performed

6. Results
1,251 patients undergoing axillary to femoral bypass were identified

7. Indication for all axillary to femoral bypass
Results
Indication for all axillary to femoral bypass

8. Axillounifemoral (N=412)
Results
Characteristic
Overall
(N=1251)
Axillounifemoral (N=412)
Axillobifemoral (N=839)
P-Value
Age (mean±SD)
68.3±10.1
67.4±10.1
68.8±10.1
.022
Male
639 (51.1%)
232 (56.3%)
407 (48.5%)
.009
Ambulatory
759 (60.8%)
224 (54.6%)
535 (63.8%)
.002
Diabetes
387 (31%)
146 (35.6%)
241 (28.7%)
.013
Prior bypass
388 (31%)
240 (58.3%)
148 (17.6%)
<.001
Prior aneurysm repair
80 (6.4%)
38 (9.2%)
45 (5%)
.004
Prior peripheral vascular intervention
365 (29.2%)
172 (41.8%)
193 (23%)
Prior major amputation
92 (7.4%)
73 (17.8%)
19 (2.3%)
Pre-operative anticoagulation
169 (15.6%)
93 (26.4%)
76 (10.4%)

9. Results
P=.017
P<.001
P<.001
P<.001
P<.001

10. Freedom from graft occlusion
P=.074
Axillobifemoral: 71.8%
Axillounifemoral: 62.6%

11. Freedom from MALE P=.052 Axillobifemoral: 66.6%
Axillounifemoral: 57.1%

12. Freedom from Major Amputation
Axillobifemoral: 73%
Axillounifemoral: 63.7%

13. Survival
P=.897
Axillounifemoral: 86%
Axillobifemoral: 86%

14. Multivariable analysis
Risk factors for Occlusion or Mortality at 1 year HR
95% CI
P-Value
Axillounifemoral vs Axillobifemoral
1.06
.77 – 1.46
.722
Tissue loss vs Claudication
2.22
1.51 – 3.28
<.001
Non-ambulatory status
1.67
1.25 – 2.23
.001
Age (per year)
1.02
1 – 1.03
.044

15. Multivariable analysis
Risk factors for MALE or Mortality at 1 year HR
95% CI
P-Value
Axillounifemoral vs Axillobifemoral
.97
.73 – 1.3
.853
Tissue loss vs Claudication
2.13
1.51 – 3
<.001
No prior bypass
1.42
1.06 – 1.91
.021
Profunda vs Common femoral target
1.36
1.02 – 1.81
.034
Age (per year)
1.02
1 – 1.03
.017

16. Multivariable analysis
Risk factors for Amputation or Mortality at 1 year HR
95% CI
P-Value
Axillounifemoral vs Axillobifemoral
1.12
.83 – 1.51
.45
Tissue loss vs Claudication
3.23
2.13 – 4.89
<.001
Rest pain vs Claudication
1.72
1.12 – 2.63
.013
Non-ambulatory status
1.5
1.13 – 2
.005
Age (per year)
1.02
1.01 – 1.03
.008

17. Multivariable analysis
Risk factors for Mortality at 1 year HR
95% CI
P-Value
Axillounifemoral vs Axillobifemoral
.91
.65 – 1.26
.552
Tissue loss vs Claudication
2.22
1.43 – 3.45
<.001
Non-ambulatory status
1.64
1.2 – 2.25
.002
Age (per year)
1.03
1.02 – 1.05

18. Limitations Retrospective study No graft size data
No data for quality of outflow
Longer term follow up data such as patency limited beyond survival

19. Conclusion
Axillounifemoral and axillobifemoral grafts have similar outcomes
Graft patency was not significantly different between axillounifemoral and axillobifemoral at 1 year
Significant risk factors for 1-year graft occlusion/MALE/any amputation/death were tissue loss, non-ambulatory status, and older age
Overall, these patients have many comorbidities and have low long-term survival

20. Thank you