Axillofemoral bypass in elderly patients with local anesthesia: an alternative route to less risk

Background The evolution of medical and minimally invasive techniques have led to improved outcomes in limb salvage in elderly patients. In particular, has improved the overall survival of the patients and life expectancy. The patient with major amputation have high rates of mortality and morbidity and health care cost with a considerable impact on society. The work presented here concerns elderly patients with aorto iliac occlusive disease and limb ischemia with and without ulcers. Today revascularisation technique of choice, in these patients, is the endovascular recanalization. In some cases, this technique is not feasible due to the impossibility to cross the occlusions (about 10% of the procedures). The aortofemoral bypass “anatomical” is to be preferred to the “extranatomical” because it has best primary and secondary patency rates [1-4]. In patients with high surgical risk and big morbility is not advisable to realize the aorto-femoral bypass for the high operative risk. In these patients, the only alternative to major amputation is the bypass extranatomical (femoro-femoral or axillofemoral). We prefer to use a spinal anesthesia with high back puncture for femoral access associated with a local anesthetic for axillary access. This approach reduces both the risk: free surgical opening of the abdomen and general anesthesia. The aim of treatment is limb salvage. In fact, at times, it is observed that patients do not return to critical ischemic phase even if the graft is occluded. In patients treated the intervention is well accepted. The patient does not require post-operative intensive care, begin to ambulate early and requires low doses of painkiller. Patients who may benefit from this treatment are those with too much risk for aortic revascularization. We prefer to avoid the femoro-femoral bypass because of controlateral limb have latent ischemic arterial disease that may worsen afther robbery blood graft.