From the Guidelines
Some degree of swelling and irritation around an axillary bifemoral bypass graft is normal in the early post-operative period, as the body responds to the foreign object and heals. This reaction is part of the inflammatory response to surgery, which typically subsides over several weeks as healing progresses 1. The expected patency rate of axillofemoral-femoral bypass is lower compared to other procedures like aortobifemoral bypass, with 5-year patency rates ranging from 63 to 67.7% 1.
Post-Operative Care
To minimize irritation and promote healing, patients should:
- Follow their surgeon's instructions regarding activity restrictions, wound care, and medication
- Avoid heavy lifting and strenuous activities for 4-6 weeks
- Wear loose clothing that doesn't rub against the graft sites
- Monitor for signs of infection or complications, such as severe swelling, increasing pain, redness that spreads, drainage from the incision sites, or fever, and contact their healthcare provider immediately if they occur.
Complications and Risks
Axillofemoral-femoral bypass is associated with lower patency rates compared to other procedures, and patients should be aware of the potential risks and complications, including infection, graft failure, and cardiovascular events 1. However, with proper care and monitoring, many patients can recover successfully and experience improved symptoms and quality of life. The body eventually incorporates the synthetic graft material through a process called endothelialization, where cells line the inner surface of the graft, making it less likely to cause ongoing irritation once healing is complete.
From the Research
Axillary Bifemoral Bypass Graft Complications
- The available studies do not directly address the normalcy of irritation or swelling around an axillary bifemoral bypass graft 2, 3, 4, 5, 6.
- However, the studies suggest that complications such as infection, thrombosis, and graft failure can occur after axillary bifemoral bypass surgery 2, 3, 4, 5, 6.
- Infection of the graft can lead to serious consequences, including perioperative mortality and amputation 2, 6.
- Graft thrombosis and failure can also result in limb loss if not treated promptly and effectively 3, 6.
- The management of failed and infected axillofemoral grafts often requires remedial procedures, such as thrombectomy, graft revision, and secondary reconstruction 6.
Graft Patency and Outcomes
- The studies report varying patency rates for axillary bifemoral bypass grafts, ranging from 37% to 83.7% at 5 years 3, 4, 5.
- The type of graft configuration, such as axillary-unifemoral or axillary-bifemoral, does not seem to significantly affect patency rates or outcomes 5.
- Patient demographics, comorbidities, and operative details can influence the success of the procedure and the patient's overall outcome 4, 5.
- Regular follow-up and monitoring are essential to detect potential complications and ensure the long-term success of the graft 4, 5, 6.