Aortoiliak Oklüzyonu Olan Yüksek Riskli Hastalarda Alternatif Cerrahi Yaklaşım: Lokal Anestezi ile Aksillofemoral Bypass

Objective: Extra-anatomic bypass approaches have been used as alternative methods in surgical treatment of peripheral artery disease for a long time. Gradual increase in average life expectancy caused atherosclerotic vascular problems to be encountered more often. In patients with aortoiliac occlusions who are not suitable for endovascular treatment, surgical treatment is very important for relief of symptoms due to extremity ischemia and to improve the quality of life. However, conventional anesthesia methods (general or spinal) increase mortality and morbidity due to possible complications, particularly in elderly patients with cardiac and pulmonary disorders. Therefore, limb ischemia may be reduced with less invasive methods. Axillofemoral bypass which is an extra-anatomic approach performed under local anesthesia has been known to have a positive effect on mortality and morbidity. Material and Methods: We performed 12 axillofemoral bypasses in high-risk patients between 1999-2015, and analyzed the short- and mid-term results. Results: There were no in-hospital mortalities. The graft patency rate of these patients was determined 70% in a mean follow up period of 36 months. There were neither extremity amputations nor mortality in this period. Conclusion: We suppose that axillofemoral bypass under local anesthesia is a reliable and a feasible method in selected patients with aortoiliac occlusion who are considered to have high risk for conventional anesthesia.