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Obturator Foramen Bypass: Long Term Results of a French Case Series
Federico Pascucci1, Jennifer Canonge1, Marie Corniquet1
1Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
Insights
Obturator foramen bypass (OFB) is a life-saving technique for complex lower limb revascularization, showing good long-term patency and wound healing. Despite a notable early mortality rate due to patient severity, OFB offers limb salvage in challenging groin cases.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Arterial Bypass
Background:
- Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularization technique.
- It is particularly useful in cases with hostile groins, often due to infection.
- Despite its potential, OFB is technically demanding and not widely utilized.
Purpose of the Study:
- To report the long-term outcomes of obturator foramen bypass procedures.
- To evaluate the efficacy and safety of OFB in a series of patients.
- To assess survival, patency, and complication rates associated with OFB.
Main Methods:
- A retrospective, observational, single-center study was conducted.
- Consecutive patients undergoing OFB between 2002 and 2024 were included.
- Data analyzed included pre-operative characteristics, intra-operative details, and post-operative outcomes (survival, patency, wound healing, re-infection, limb salvage).
Main Results:
- 26 patients underwent OFB, with a mean age of 64 years; 81% had extensive groin infection.
- 37-month mean follow-up revealed a 60% survival rate at 3-5 years and 83% primary patency at 2-5 years.
- A 15% 30-day mortality rate was observed, linked to severe patient conditions; no bypass re-infections occurred.
Conclusions:
- Obturator foramen bypass can be a limb- and life-saving procedure in selected patients at experienced centers.
- Long-term patency and wound healing rates are satisfactory.
- The procedure requires thorough technical knowledge and vigilant post-operative follow-up due to associated risks and patient comorbidities.
Introduction:
Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularisation technique useful in hostile groin cases. Although described during the 1960s, this operation is often considered technically demanding and not widely used nowadays. This study reports the long term outcomes of a series of OFBs.
Method:
This was a retrospective, observational, single centre study. All consecutive patients who underwent an OFB between 2002 and 2024 at the Henri Mondor University Hospital were included. Pre-operative patient characteristics, as well as intra-operative and post-operative data were analysed. Primary outcomes were survival and primary and secondary patency. Secondary outcomes were wound healing, freedom from re-infection, and limb salvage.
Results:
Between 2002 and 2024, 26 patients underwent an OFB; 18 were men (69%). The mean age was 64 ± 12 years. In 21 cases (81%) the surgical indication was extensive groin infection with native vessels or prosthetic material involvement. In six cases (23%), the operation was performed under emergency conditions. A cryopreserved arterial allograft was the conduit of choice in 16 cases (62%). Mean follow up was 37 ± 8 months (range, 0-129). The thirty day mortality rate was 15%. Survival rate at 12, 24, and 36-60 months was 73%, 67%, and 60%, respectively. The primary patency rate was 88% at 12 months and 83% at 24-60 months. An early re-intervention was needed in eight patients (31%), mostly for local wound debridement. There were no cases of bypass re-infection requiring removal.
Conclusion:
Obturator foramen bypass can be a limb and lifesaving procedure in selected cases and experienced centres. Long term patency and wound healing rates are satisfactory. The authors reported a non-negligible early mortality rate, which is associated with the severe initial condition of these patients, often admitted with septic or haemorrhagic shock, and affected by multiple comorbidities. Thorough knowledge of the technique and continuous post-operative follow up are mandatory to eventually prevent and treat complications.
