Femorofemoral bypass grafts: ten-year experience

From August 1972 to September 1982, one of us (F.R.P.) performed 119 femorofemoral bypass grafts on 78 men and 35 women with an average age of 62 years. Axillofemorofemoral grafts were excluded. The 30-day operative mortality rate was 1.7% (2 of 119). The cumulative patency rates determined by the life-table method were 97.4% at 30 days, 95.1% at 1 year, 83.3% at 3 years, 72.2% at 5 years, and 55% from 6 through 10 years. There were no graft failures in the 21 patients followed up for more than 6 years. There were 21 grafts at risk at 7 years, 15 at 8 years, 10 at 9 years, and four at 10 years. Donor iliac arteries were judged to be acceptable by a combination of simple analyses including physical examination, noninvasive laboratory testing, angiography, and intraoperative direct blood pressure measurements. There was no evidence of a vascular steal in any of the postoperative patients. One patient required an inflow procedure 2 years following femorofemoral grafting. Two patients required resection of an abdominal aortic aneurysm 2 and 3 years, respectively, following femorofemoral grafting. There was one early graft failure secondary to infection, and five grafts became infected at 20,29,33,46, and 62 months, respectively, following femorofemoral grafting. False aneurysm formation, diabetes, and trauma were significant factors in these infections. Initially only high-risk patients were selected as candidates for femorofemoral grafting. Because we were encouraged by the early success rate and the apparent durability of the method, the indications were broadened to include good-risk patients who met rigid criteria for femorofemoral grafting.