Aortofemoral Bypass Mortality
Aortofemoral bypass carries an operative mortality rate of 3.3%, based on comprehensive meta-analysis of over 8,000 procedures. 1
Mortality Data from High-Quality Evidence
The ACC/AHA guidelines, drawing from a meta-analysis of 8,123 aortobifemoral bypasses, establish the benchmark mortality rate at 3.3% with an associated morbidity of 8.3%. 1 This represents the most robust data available from multiple large series and should guide patient counseling and risk stratification.
Major Causes of Perioperative Mortality and Morbidity
The primary drivers of operative mortality and serious morbidity include:
- Myocardial infarction: occurs in 0.8% to 5.2% of cases 1
- Renal failure: occurs in 0% to 4.6% of cases 1
These cardiovascular and renal complications account for the majority of perioperative deaths, reflecting the systemic atherosclerotic burden in this patient population.
Comparison with Alternative Procedures
Aortofemoral bypass has significantly lower mortality than major amputation, which carries a 30-day mortality of 4-30%. 2 This mortality advantage, combined with superior functional outcomes, makes revascularization the preferred approach when technically feasible.
Alternative bypass procedures show variable mortality:
- Femorofemoral bypass: 6% operative mortality 1
- Axillofemoral bypass: 6% operative mortality 1
- Axillofemoral-femoral bypass: 4.9% operative mortality 1
Long-Term Survival
Beyond the perioperative period, patient survival rates are:
Late deaths are predominantly due to ischemic heart disease and malignancy, reflecting the systemic nature of atherosclerotic disease. 3
Critical Risk Stratification Factors
Patients undergoing surgery for claudication have significantly better 5-year survival (96%) compared to those requiring limb salvage (70%). 3 This distinction is crucial for preoperative counseling and patient selection.
The presence of comorbid cardiovascular disease substantially influences both operative risk and long-term outcomes. 1 Patients deemed high cardiovascular or surgical risk should be considered for alternative procedures such as axillofemoral-femoral bypass, despite inferior patency rates. 1
Clinical Context for Decision-Making
The 3.3% operative mortality must be weighed against the natural history of critical limb ischemia, where major amputation becomes necessary in many untreated patients, carrying both higher mortality (4-30%) and devastating functional consequences. 2
For patients with lifestyle-limiting claudication or critical limb ischemia who are acceptable surgical candidates, aortobifemoral bypass remains the gold standard intervention, offering excellent long-term patency (87.5% at 5 years) with acceptable mortality risk. 1