Transiliac bone tunnel route for lower limb vascular reconstruction

Area of Science:

• Vascular Surgery
• Oncology
• Reconstructive Surgery

Background:

• Major oncovascular resections in irradiated or infected groins pose challenges for standard arterial/venous reconstruction due to hostile local conditions and high reinfection risks.
• Extra-anatomic bypasses are considered when conventional in-line reconstructions are unfeasible, aiming to maintain limb viability.

Purpose of the Study:

• To describe the technical principles, perioperative management, and clinical outcomes of trans-iliac bone tunnel bypass (TIBB) in complex oncovascular cases.
• To evaluate TIBB as a limb salvage strategy for arterial and venous reconstruction in challenging groin environments.

Main Methods:

• Retrospective review of two cases undergoing TIBB for arterial and venous reconstruction.
• Detailed description of the TIBB technique involving retroperitoneal iliac exposure, iliac wing bone tunneling, and lateral graft routing.
• Assessment of hemodynamic results, infection control, graft patency, and limb outcomes.

Main Results:

• TIBB successfully provided durable limb perfusion (arterial) and venous outflow (venous) in both cases.
• Arterial reconstruction remained patent without reinfection at mid-term follow-up.
• Venous bypass led to significant limb edema reduction and maintained graft patency.

Conclusions:

• Trans-iliac bone tunnel bypass is a reproducible and effective limb salvage strategy for selected oncovascular patients.
• TIBB offers a protected, extra-anatomic route, successfully avoiding contaminated or irradiated fields.
• This technique is a viable alternative when conventional reconstructive options are unsafe or unfeasible.