Review of Indications for Extra-anatomic Bypass

Abstract

In most centres for vascular surgery, the indications for extra-anatomic bypasses are sufficiently limited. In some places, however, the number of extra-anatomic bypasses is surprisingly large. The reason for this seems to be unacceptably broad indications for the extra-anatomic procedure. It may thus be of interest to discuss the indication for one type of extra-anatomic bypass, the axillofemoral, which is performed in high risk patients due to its simpliCity and safety. The most common type of high risk patients in vascular surgery reported in the literature are the following: high risk not suitable for aortoiliac reconstruction, cardiopulmonary disease, cancer, massive abdominal adhesion, poor risk for laparotomy, advanced age, infected synthetic grafts, and poor general condition. In practically all reports there is a lack of detailed information of the type and degree of high risk. It seems as if the justifications for selecting a patient as a high risk and therefore as a candidate for extra-anatomic bypass procedure are rather loose. It gives the impression that the choice is made in order to allow the use of an extraordinary operative procedure.