Is femorofemoral crossover bypass an option in claudication?

Since the introduction of femorofemoral crossover bypass by Freeman and Leeds in 1952 (Calif Med 1952;77:229-233), it has been used as an alternative to anatomic surgical reconstruction for unilateral iliac disease. The objective of this review was to summarize results on femorofemoral crossover bypass surgery for disabling claudication from the most recent studies.

All publications describing series or registries of patients treated for claudication by femorofemoral crossover bypass were sought through computerized searches of MEDLINE database. Main outcome measures considered for comparisons were primary and secondary patency rates; mortality; complications such as infection, amputation, or loss of function; improving walking distance or ankle-brachial index; Quality of Life (QoL) variations.

Six studies met the inclusion criteria. In the considered series, primary interventions were performed with Dacron, polytetrafluoroethylene (PTFE) or autologous vein graft. The number of patients treated for claudication ranged from 66 to 211 in the considered series. One-year primary patency rates ranged from 71.6 to 96%. In two series, 5-year primary patency rates reported were 71.8 and 72%, and in one series secondary patency rate at 5 years was 89%.

The femorofemoral crossover bypass in patients with disabling claudication caused by unilateral iliac artery disease is still a valuable alternative to aortofemoral grafting in those who are not suitable for endovascular repair or major abdominal surgery, or have poor general (age, coronary artery disease, chronic obstructive pulmonary disease (COPD), etc.) or local (hostile abdomen, sepsis, porcelain aorta) conditions, presenting in recent series with good long-term patency and low complication rates.