Obturator Bypass Remains a Useful Option

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Arterial Reconstruction

Background:

• The femoral tripod is critical for vascular surgery, but managing septic complications and healing disorders is challenging.
• Obturator bypass (OB) is an alternative approach for complex femoral artery conditions.
• Recent data on OB outcomes are limited, necessitating further evaluation.

Purpose of the Study:

• To evaluate the efficacy of obturator bypass (OB) in vascular surgery.
• To assess OB outcomes regarding graft patency, morbidity, mortality, healing, and reinfection rates.
• To determine the relevance of OB as an alternative for complex femoral tripod lesions.

Main Methods:

• A monocentric retrospective study was conducted from January 2010 to December 2020.
• Included patients underwent obturator bypass (OB) for various indications.
• Primary outcomes: primary and secondary patency rates. Secondary outcomes: morbidity, mortality, infection rates, and healing.

Main Results:

• 23 OBs were performed in 22 patients (77% male, median age 70). Indications included infection (86%) and thrombosis (14%).
• Arterial allografts were used in 82% of cases. Median operative time was 224 minutes; median blood loss was 900 mL.
• 90% healing rate and 100% freedom from infection were achieved. One-year primary patency was 84%; secondary patency was 94%.

Conclusions:

• Obturator bypass (OB) is a relevant alternative for complex femoral tripod lesions, demonstrating good patency, healing, and infection control.
• OB is associated with significant morbidity and mortality, classifying it as major surgery.
• OB should be reserved for situations where traditional surgical approaches are not feasible.