Aortobipopliteal bypass via the obturator foramina
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V S Sottiurai1, B Smith, P Dial
1Department of Surgery, Louisiana State University School of Medicine, New Orleans.
Insights
For patients with severe aortoiliac disease and failed bypasses, aortopopliteal bypass through obturator foramina offers a viable alternative. This surgical approach can improve limb perfusion and potentially avoid amputation.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Peripheral Artery Disease
Background:
- Patients with extensive aortoiliac disease often face limited treatment options after multiple bypass failures.
- Successive occlusions of aortofemoral, femoro-femoral, and axillo-femoral bypasses, along with thrombectomies, lead to a very poor prognosis, frequently necessitating amputation.
Observation:
- A novel surgical technique, aortobipopliteal bypass via the obturator foramina, was employed in patients with complex aortoiliac disease.
- This approach bypasses the groin collateral vessels, which are often unsuitable for further bypass procedures in these challenging cases.
Findings:
- Three patients successfully underwent aortobipopliteal bypass using Dacron or PTFE prostheses.
- Post-operative ankle-brachial indices improved significantly (0.3-0.6), indicating enhanced lower limb perfusion.
- Graft patency was observed, with one graft remaining functional for five years and two others patent since 1983.
Implications:
- Aortobipopliteal bypass via obturator foramina presents a promising alternative for limb salvage in patients with end-stage aortoiliac disease.
- This technique may reduce the need for amputation and improve wound healing in previously untreatable cases.
- Further research into long-term outcomes and patient selection is warranted.
Abstract:
Patients with aortoiliac disease who have successive occlusion of aortofemoral bypass, femoro-femoral bypass, axillo-femoral bypass, and multiple thrombectomies have a very poor prognosis. In these patients, amputation is frequently inevitable and wound healing is often a problem. Aortobipopliteal bypass via the obturator foramina, without disturbing the collateral vessels which are unsuitable for bypass at the groin, is an alternate approach in the management of this type of patient. Three cases have been successfully constructed using dacron (No. 1) or PTFE (No. 2) prostheses with improvement of ankle brachial indices (0.3-0.6). One graft was patent for five years before occlusion of one limb. Two grafts have remained patent since 1983.