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Bypass to the lateral circumflex femoral artery
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
Severe aortoiliac disease can be treated by bypassing the lateral circumflex femoral artery when other options fail. This approach provides suitable outflow, avoiding further amputation.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
Background:
- Severe aortoiliac disease often leads to critical limb ischemia.
- Total occlusion of major femoral arteries presents a surgical challenge.
Observation:
- Two patients with severe aortoiliac disease and complete femoral artery occlusion were treated.
- Bypass to the lateral circumflex femoral artery (LCFA), a proximal profunda femoris branch, was performed.
Findings:
- Successful bypass to the LCFA was achieved in both patients.
- One patient received an aortobifemoral graft to bilateral LCFAs; no further distal bypass was needed.
- The second patient had a saphenous vein bypass to the LCFA, preventing an above-knee amputation revision.
Implications:
- The LCFA is a viable outflow target in complex aortoiliac occlusive disease.
- This technique can salvage limbs and avoid extensive amputations.
Abstract:
Two patients with severe aortoiliac disease presented with total occlusion of all major femoral arteries, including the distal profunda femoris artery. Bypass to the lateral circumflex femoral artery, the most proximal branch of the profunda femoris artery, was successful in each patient. One patient had a bifurcated Dacron graft implanted from the aorta to the lateral circumflex femoral artery on each side. No sequential bypass to more distal vessels has since been necessary. The second patient underwent bypass to the lateral circumflex femoral artery from the contralateral femoral artery using saphenous vein. The procedure obviated the need to revise an above-knee amputation. The lateral circumflex femoral artery can provide suitable outflow in patients with thrombosis of the entire profunda femoris artery.