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Abstract Title: Risk Factors Influencing Axillofemoral Bypass Outcomes Author(s): Niv Bhide, OMS II; Caila Tongco, OMS II; Hayden Gorham, OMS II; Christian Heck, PhD Background: Axillofemoral bypass (AxFB) is an extra-anatomic procedure performed to restore blood flow to the lower limbs in cases of abdominal vascular blockage. AxFB is elected over the more invasive Aortofemoral Bypass (AoFB) when a patient is at greater perioperative risk due to comorbidities. This literature review aims to consolidate information on how managing risk factors affects post-operative outcomes of AxFB. Methods: A literature review was conducted using PubMed, CINAHL, and ClinicalKey through Boolean searches with the following terms: ("axillofemoral bypass" OR "axillobifemoral bypass") AND ("graft surviv*" OR "mortality" OR "graft failure" OR "complications") AND ("risk factors") AND ("aortoiliac occlusive disease"). Inclusion criteria were full-text articles in English addressing graft patency. Case reports, case series, and articles on aortic aneurysms were excluded. Results: A total of 50 articles were initially returned, 11 of which fit the exclusion/inclusion criteria. 3 articles provided hazard ratios or odds ratios comparing preoperative risk factors and postoperative outcomes. All 3 articles found worse outcomes (bypass occlusion, amputation, reintervention, cardiovascular events, and mortality) significantly associated with poor left ventricular function. 2 articles found worse outcomes with preoperative anticoagulant administration, anemia (Hb<10), and poor kidney function (ESKD or increased creatinine). Protective factors varied among the articles, but included postoperative anticoagulation, never-smokers, and those with a high BMI. Poor preoperative Society of Vascular Surgery (SVS) guideline adherence was noted, with 30% of patients not taking recommended statin therapy before surgery. 47-60% were current smokers, even though guidelines recommend smoking cessation before surgery. Conclusion: Our results indicate a correlation between clinically manageable risk factors and worse outcomes. However, most of the current research on AxFB is focused on establishing the indications for AoFB vs AxFB, and many studies did not report complete data sets or multivariate analyses comparing comorbidities and outcomes. This review identifies the need for further data publication on how risk factor management and preoperative medications can impact bypass survival. This review also highlights an area for improvement of adherence to preoperative surgical guidelines.