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Crossover femoropopliteal bypass: single graft or double grafts
Orhan Gokalp1, Ismail Yurekli, Levent Yilik
1Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
Insights
Single-graft crossover femoropopliteal bypass and double-graft procedures offer comparable limb salvage for critical limb ischemia. Both methods effectively improve ankle-brachial indices, with no significant differences in major postoperative outcomes.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Reconstructive Surgery
Background:
- Patients with prior abdominal vascular surgery or comorbidities often cannot undergo standard aortic reconstruction.
- Alternative bypass techniques are necessary for limb salvage in these complex cases.
- Crossover femoropopliteal bypass (COFP) and double-graft procedures are considered.
Purpose of the Study:
- To compare the outcomes of single-graft COFP bypass versus double-graft crossover femorofemoral plus femoropopliteal bypass.
- To evaluate the efficacy of these bypass methods in patients ineligible for traditional aortic reconstruction.
Main Methods:
- Retrospective study of 15 patients (Fontaine class 3 or 4) between 2002 and 2010.
- Group 1: 8 patients with double-graft femorofemoral and femoropopliteal bypass.
- Group 2: 7 patients with single-graft COFP bypass. Preoperative imaging and postoperative ankle-brachial indices (ABIs) were assessed.
Main Results:
- Median primary patency: 40.5 months (Group 1) vs. 42 months (Group 2).
- Median secondary patency: 58 months (Group 1) vs. 44 months (Group 2).
- Both groups showed significant postoperative ABI improvement (P < 0.05); no significant differences in hospital stay, ICU stay, or blood transfusions.
Conclusions:
- Single-graft COFP bypass is a viable option for limb salvage in critical limb ischemia patients with complex medical histories.
- Both single and double-graft bypass techniques provide comparable clinical benefits for select patient populations.
- Continuous COFP bypass using a single graft can be effectively performed.
Background:
Both single-graft crossover femoropopliteal (COFP) bypass and crossover femorofemoral plus femoropopliteal bypasses using double grafts may be performed for patients with a medical history of abdominal vascular operations or comorbidity, thereby ineligible for retroperitoneal or transperitoneal approaches. In this study, these two methods were compared.
Methods:
A total of 15 patients who were operated on between February 2002 and March 2010 were included and studied retrospectively. Eight of them underwent crossover femorofemoral bypass plus femoropopliteal bypass with double grafts (group 1), whereas the rest seven underwent single-graft COFP bypass (group 2). All the patients were included either in class 3 or class 4 according to Fontaine classification. Preoperative arterial Doppler ultrasound and arteriography were obtained from every patient. Pre- and postoperative ankle-brachial indices were measured. Postoperative clinical parameters were obtained from medical records.
Results:
Median primary and secondary patency rates were 40.5 (7-105) months and 58 (7-105) months in group 1, respectively. In group 2, these rates were 42 (2-84) months and 44 (11-84) months, respectively. Two patients in group 1 and one patient in group 2 were amputated. There were no significant differences between both groups in terms of duration of hospital stay, duration of intensive care unit stay, and units of packed red blood cells transfused (P > 0.05). In addition, postoperative ankle-brachial indices were significantly improved in both groups (P < 0.05). COFP bypass can be performed for limb salvage in cases with critical limb ischemia with a medical history of previous vascular surgery or comorbidity, thereby ineligible for aortic reconstruction.
Conclusion:
This procedure may also be performed as continuous COFP bypass using a single graft.
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