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Utility of femorofemoral bypass. Comparison of results with indications for operation
S B Self1, J D Richardson, T W Klamer
1Department of Surgery, University of Louisville School of Medicine, Kentucky 40292.
Insights
Femorofemoral bypass (FFB) is effective for limb salvage in acute ischemia or failed vascular prostheses. However, its use as a primary procedure in good-risk patients is not supported due to limited patency rates.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
Background:
- Femorofemoral bypass (FFB) is a surgical procedure used to treat peripheral artery disease.
- Indications for FFB include acute limb ischemia, chronic ischemia after failed aortic reconstruction, and as an alternative for high-risk patients.
Purpose of the Study:
- To evaluate the outcomes of femorofemoral bypass (FFB) in a diverse patient population.
- To assess the efficacy of FFB in terms of graft patency, limb salvage, and operative mortality.
Main Methods:
- Retrospective analysis of 68 patients who underwent femorofemoral bypass (FFB) between 1980 and 1989.
- Patients were categorized based on the indication for surgery: acute ischemia, chronic ischemia post-aortic reconstruction, elective FFB in good-risk patients, and FFB in poor-risk patients.
Main Results:
- Infectious complications were significant in patients operated on for acute ischemia, contributing to graft failure.
- The 5-year primary patency rate was 42%, with similar rates across all patient groups.
- Overall operative mortality was 4.4%, and limb salvage rates were 75%.
Conclusions:
- Femorofemoral bypass (FFB) is a viable option for limb salvage in patients with acute ischemia or those with a failed vascular prosthesis.
- FFB can provide adequate inflow for poor-risk patients unsuitable for aortic reconstruction.
- The patency rates do not support the use of FFB as a primary procedure of choice in good-risk patients.
Abstract:
Sixty-eight patients underwent femorofemoral bypass (FFB) at the University of Louisville Affiliated Hospitals over a 9-year period from 1980 to 1989. There were patients with acute ischemia requiring emergency operation, those with chronic ischemia following failed aortic reconstruction, good-risk patients with chronic ischemia who had FFB as the procedure of choice, and poor-risk patients who were unsuitable for other procedures. Patients operated on for acute ischemia had a significant number of infectious complications, with five of eight graft failures in this group due to infection. Primary patency rates were similar in all groups, with a 5-year primary patency of 42 per cent. Overall operative mortality was 4.4 per cent. Satisfactory limb salvage rates (75%) suggest that FFB is an acceptable option for providing inflow in patients with acute ischemia or for patients with a failed previous vascular prosthesis. FFB provides adequate inflow in poor-risk patients not suitable for aortic reconstruction, but patency rates do not warrant its use as a procedure of choice in good-risk patients.
