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The femoro-femoral cross-over bypass
L N van Adrichem1, D P van Berge Henegouwen, H J Lobach
1Department of Surgery, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.
Insights
Femoro-femoral cross-over bypass is effective for unilateral iliac artery occlusion. This procedure offers good patency and limb-salvage rates, especially in primary cases for critical ischemia.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- Unilateral iliac artery occlusion presents treatment challenges.
- Central reconstruction may be unsuitable for certain patient groups (e.g., elderly, comorbidities).
- Previous aortobifemoral bypass failure necessitates alternative revascularization strategies.
Purpose of the Study:
- To evaluate the efficacy and outcomes of femoro-femoral cross-over bypass.
- To assess patency rates and limb salvage in patients with unilateral iliac artery occlusion.
- To determine the suitability of cross-over bypass as a primary treatment option.
Main Methods:
- Retrospective analysis of 64 patients undergoing femoro-femoral cross-over bypass (1984-1990).
- 45 primary and 19 secondary procedures were performed.
- Patient selection considered factors precluding central reconstruction and previous bypass failures.
Main Results:
- Overall three-year patency rate was 78%.
- Primary cross-over bypasses demonstrated high patency (80% primary, 85% secondary).
- Favorable limb salvage (91%) was achieved in 23 primary cases for critical ischemia (Fontaine stage III/IV).
- Mortality rate was 5% (3 patients).
Conclusions:
- Femoro-femoral cross-over bypass is a recommended first-choice therapy for unilateral iliac artery occlusion.
- The procedure shows excellent outcomes, particularly for primary interventions in critical limb ischemia.
- It provides a viable alternative when central reconstruction is contraindicated or previous bypasses have failed.
Abstract:
From 1984 to 1990 64 patients (56 men and 8 women) with a mean age of 67.1 years (36-88 yrs.) were treated with a femoro-femoral cross-over bypass (45 primary and 19 secondary procedures). All patients had an occlusion of one iliac artery. In 26 patients there were factors that made a central reconstruction unattractive. These disorders were congestive heart failure, COPD, CVA, an age over 80 years, etc. In 19 patients an occlusion of one leg of a former aortobifemoral bypass determined the choice for cross-over bypass. Three patients died (5 per cent), two patients of the so-called redo-group (septicaemia, one patient and arteriojejunal fistula one patient), the third patient died after a primary femoro-femoral bypass (myocardial infarction). The overall patency rate after three years was 78 per cent. Especially primary cross-over bypasses showed a good outcome with a primary patency of 80 per cent and a secondary patency of 85 per cent after three years. Considering that 23 of the 45 (51 per cent) primary procedures were for treatment of critical ischaemia (stage III and IV of Fontaine), a favourable limb-salvage of 21 out of 23 (91 per cent) was obtained. The cross-over bypass can be recommended as first choice therapy for patients with a unilateral iliac artery occlusion.