Extraanatomic bypass-prolongation after aorto-respectively ilio-femoral inflow repair

Redo-operations in patients with a persistent or recurrent vascular insufficiency following a triad procedure (aorto-iliac inflow repair, profundaplasty and lumbar sympathectomy) may bring on problems from re-exposure of the groin with an increased risk of wound healing complications. A new technique for bypass-prolongation, i.e.g., an extraanatomic iliopopliteal bypass (group A: n = 16) is presented as an alternative to the conventional femoro-popliteal bypass prolongation (group B: n = 55). In both groups the effect of revascularisation was sufficient and comparable for definitive healing of distal ischemic lesions in more than 85%. The cumulative patency rate in both collectives after 1 and 5 years did not differ. Group A: 82 respectively 64% versus 75.6 respectively 59.5% in group B. However, the number of redo-operations could be significantly (p less than 0.05) reduced to 12.5% (n = 2) in group A, compared with 21.8% (n = 12) in case of an anatomical bypass-prolongation (group B). There were no wound healing complications in the groin after extranatomical reconstruction, compared with 5 after femoro-popliteal prolongation. The main advantage of this new approach, is 1. avoidance of a difficult femoral redissection in the groin with reduced risk of wound infection, 2. easy extraperitoneal exposure of the prosthetic limb at iliac level and 3. optimal healing in of the graft (ePTFE with external ringsupport). Since a significant reduction of wound healing complications could be achieved, the presented technique therefore is regarded as a superior alternative to the anatomical femoropopliteal bypass prolongation.