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Femorofemoral bypass grafts: Factors influencing long-term patency rate and outcome
A Mingoli1, P Sapienza, R J Feldhaus
1Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
Insights
Crossover femorofemoral bypass graft (CFFBG) offers good outcomes for unilateral iliac artery disease, especially when performed as a primary operation with external support and adequate outflow. Previous graft failure negatively impacts long-term success.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Crossover femorofemoral bypass graft (CFFBG) was developed for high-risk patients with unilateral iliac artery disease.
- This study investigates factors influencing short- and long-term outcomes of CFFBG.
Purpose of the Study:
- To assess the effectiveness and influencing factors of CFFBG in treating unilateral iliac artery disease.
- To analyze short- and long-term outcomes, including patency and limb salvage rates.
Main Methods:
- Retrospective clinical study of 228 patients undergoing CFFBG.
- Data collected on patient demographics, surgical risk, indication for operation, and procedural details.
- Assessment of postoperative complications, patency rates (5- and 10-year), limb salvage, and survival rates.
Main Results:
- Postoperative mortality was 5.7%, higher in patients over 65.
- 5- and 10-year secondary patency rates were 82.8% and 63.2%, respectively.
- Outcomes were significantly worse following previous graft failures and with autogenous vein grafts compared to synthetic grafts. Externally supported grafts showed better patency.
Conclusions:
- CFFBG provides comparable early and long-term results to aortic reconstructions when performed as a primary operation.
- Adequate outflow provision and the use of externally supported prosthetic material are crucial for successful CFFBG outcomes.
- Previous vascular graft failure is a significant predictor of poorer long-term patency and limb salvage rates.
Background:
Crossover femorofemoral bypass graft (CFFBG) was proposed in the early days of modern vascular surgery to treat patients affected with unilateral iliac artery disease who were a high surgical risk. We investigated factors influencing short- and long-term outcomes of CFFBG:
Methods:
The study was designed as a retrospective clinical study in a university hospital setting with a base of 228 patients. Of these patients, 154 (67.5%) presented a high surgical risk. The indication for operation was limb-threatening ischemia in 188 (82.5%) patients. All patients underwent CFFBG: The procedure was performed in 150 patients as the primary operation and in 78 patients after previous vascular graft failure or infection, or both. A preoperative percutaneous transluminal angioplasty was performed in 57 patients (25%) to correct donor iliac artery disease. In 127 patients (55.7%), an associated vascular procedure was performed to improve the outflow. Postoperative complications; 5- and 10-year primary, secondary, and limb salvage rates; and factors influencing short- and long-term results were assessed.
Results:
Thirteen (5.7%) postoperative deaths occurred. Postoperative mortality and morbidity rates were significantly higher in patients aged more than 65 years (7.9% versus 3.5% and 18.6% versus 6.1%, respectively, P <.03). Primary and secondary patency rates at 5 and 10 years were 70.2% and 48.1%, 82.8% and 63.2%, respectively; 5- and 10-year limb salvage and survival rates were 85.5% and 80.1%, 63.3% and 31.0%, respectively. Ten-year primary and secondary patency and limb salvage rates were significantly lower when the procedure was performed after previous vascular graft failures (50.2% versus 26.5%, P <.007; 74.1% versus 44.1%, P <.01; and 84.3% versus 72.5%, P <.03, respectively). Five- and 8-year patency rates of autogenous vein CFFBG (34.3% and 22.8%, respectively, P <.03) were significantly lower than those of expanded polytetrafluoroethylene (71.1% and 59.8%, respectively) and polyester (77.3% and 50.3%, respectively) CFFBG: Moreover, 5- and 10-year primary and secondary patency rates were significantly better when externally supported grafts were used as compared with those without external support (80.1% and 69.9% versus 61.1% and 21.1%, P <.01; 88.8% and 75.9% versus 78.9% and 45.4%, P <.05, respectively). Multivariate analysis showed that the only variable associated with poor primary and secondary patency and limb salvage rates was the operation performed after previous vascular graft failures (P <.04, P <.03 and P<.05, respectively).
Conclusions:
CFFBG allows early and long-term results similar to those obtained with reconstructions originating from the aorta when it is performed as a primary operation when an adequate outflow is provided and externally supported prosthetic material is used.