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Obturator bypass: a sixteen year experience with 55 cases
A Nevelsteen1, U Mees, J Deleersnijder
1Department of Cardiovascular Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
Insights
Obturator bypass surgery for limb salvage had a 37% five-year patency rate and significant perioperative mortality. Above-knee reconstructions showed better long-term results than below-knee, suggesting careful patient selection is crucial.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Limb Salvage Procedures
Background:
- Obturator bypass is a reconstructive surgical technique used for limb salvage.
- Indications include groin infections, aneurysms, skin loss, and severe iliofemoral atherosclerotic disease.
- The procedure involves bypassing diseased arterial segments in the pelvic region.
Purpose of the Study:
- To evaluate the outcomes of obturator bypass surgery for limb salvage.
- To assess the patency rates and perioperative mortality associated with this technique.
- To compare the long-term results of above-knee versus below-knee reconstructions.
Main Methods:
- A retrospective review of 55 obturator bypass procedures performed over 16 years.
- Analysis of indications for surgery, including infection, aneurysm, skin loss, and atherosclerotic disease.
- Assessment of perioperative mortality and long-term patency rates.
Main Results:
- Five perioperative deaths occurred in 55 patients.
- The overall five-year patency rate was 37%.
- Above-knee reconstructions demonstrated significantly higher three-year patency rates (71%) compared to below-knee (45%).
Conclusions:
- Obturator bypass surgery is associated with considerable morbidity and mortality.
- The decision to perform this procedure should be reserved for specific indications like deep groin infections.
- Its utility in extensive multilevel arterial disease remains unproven and requires further investigation.
Abstract:
Fifty-five obturator bypasses were performed over a 16 year period for limb salvage. The indications for the choice of this technique included arterial infection, aneurysm formation or soft tissue skin loss at the groin (26 patients), and extensive atherosclerotic disease of the iliofemoral vessels, precluding their use for inflow or outflow (27 patients). There were five perioperative deaths and the five-year patency rate was 37%. Long-term results after above-knee reconstruction substantially exceeded those for below-knee anastomoses (three year patency rates of 71% and 45% respectively). Due to its morbidity and mortality the decision to perform an obturator bypass should be based upon sound indications such as deep infection at the groin, or extensive multilevel arterial disease. Its usefulness in extensive multilevel arterial disease is not demonstrated.