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Early experience with synchronous aorto-bifemoral and femoro-popliteal bypass grafts
R J Cuschieri1, P Gibbs, G R Wells
1Division of Surgery, Southern General Hospital, Glasgow, U.K.
Insights
This study shows that combining aorto-bifemoral and femoro-popliteal bypass surgery is safe for severe lower limb ischemia. It offers good limb salvage rates and acceptable graft patency in selected patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Reconstruction
Background:
- Severe lower limb ischemia presents a significant clinical challenge.
- Aorto-iliac and femoro-popliteal occlusive disease often require complex surgical interventions.
- Concomitant reconstructions aim to restore blood flow to the lower extremities comprehensively.
Purpose of the Study:
- To evaluate the safety and efficacy of synchronous aorto-bifemoral and femoro-popliteal reconstructions.
- To assess perioperative outcomes, graft patency, and limb salvage rates.
- To determine the feasibility of combined prosthetic bypass surgery in patients with extensive arterial disease.
Main Methods:
- A retrospective review of 51 concomitant aorto-bifemoral and femoro-popliteal bypass procedures in 39 patients over three years.
- Prosthetic materials were used for reconstructions below the inguinal ligament.
- Patient data included indications for surgery (rest pain, gangrene, claudication) and outcomes.
Main Results:
- No perioperative mortality was observed.
- Cumulative femoro-popliteal graft patency was 53% at 2 years.
- Limb salvage rate was 84.6% at 2 years for patients with critical ischemia.
Conclusions:
- Synchronous aorto-bifemoral and femoro-popliteal reconstructions are technically feasible and safe in selected patients.
- The procedure offers acceptable early graft patency and limb salvage rates.
- This combined approach is a viable option for managing extensive lower limb ischemia.
Abstract:
Over a three-year-period 51 concomitant aorto-bifemoral and femoro-popliteal reconstructions, using prosthetic materials below the inguinal ligament, were carried out in 39 patients, with both aorto-iliac and femoro-popliteal disease, presenting with severe lower limb ischaemia. Thirteen grafts were inserted for rest pain and/or gangrene, while 38 were performed for disabling claudication. There was no perioperative mortality. Cummulative patency for all femoro-popliteal grafts was 53% at 2 years. Limb salvage rates of 84.6% at 2 years were achieved in patients with critical ischaemia. These results suggest that synchronous aorto-bifemoral and femoro-popliteal reconstructions with prosthetic materials can be performed safely in selected patients with acceptable early patency and limb salvage rates.