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Hemodynamic and angiographic guidelines in selection of patients for femorofemoral bypass
Insights
Crossover femorofemoral bypass surgery offers good long-term patency. Proper patient selection, considering iliac artery stenosis and outflow disease, is crucial for successful outcomes in peripheral artery disease treatment.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Crossover femorofemoral bypass grafts demonstrate favorable long-term patency rates.
- However, not all patients achieve complete symptomatic relief following the procedure.
Purpose of the Study:
- To evaluate the long-term outcomes and identify factors influencing success in patients undergoing femorofemoral bypass.
- To establish guidelines for optimal patient selection for this procedure.
Main Methods:
- A retrospective analysis of 80 femorofemoral bypass procedures in 71 patients (1968-1978).
- Preoperative and postoperative hemodynamic assessments using segmental Doppler pressures and femoral artery waveforms.
- Routine preoperative and selective postoperative arteriography.
Main Results:
- Twenty-nine graft failures were primarily associated with donor iliac artery stenosis (>50%) or severe recipient limb outflow disease.
- Ten patients with normal outflow and 10-50% iliac stenosis had successful reconstructions.
- Cumulative five-year patency was 74% with a 3.8% operative mortality.
Conclusions:
- Femorofemoral bypass is a viable primary procedure when specific guidelines for patient selection are followed.
- Careful assessment of iliac artery stenosis and recipient limb outflow is critical for optimizing surgical success.
Abstract:
Although crossover femorofemoral grafts have had good long-term patency, all patients have not been symptomatically improved. Seventy-one patients underwent 80 femorofemoral bypasses from 1968 to 1978. Hemodynamic assessment included preoperative and postoperative segmental Doppler pressures and femoral artery waveform recordings. Preoperative and selective postoperative arteriography was routinely performed. Twenty-nine failures occurred predominantely in two groups, those with greater than 50% stenosis of the donor iliac artery and those with severe recipient limb outflow occlusive disease. Ten patients with normal outflow beds bilaterally associated with 10% to 50% stenosis of the donor iliac artery underwent successful femorofemoral reconstruction. Progression of donor iliac artery disease was seen in only two patients. Cumulative five-year patency was 74%. Operative mortality totaled three (3.8%). This study supports the use of femorofemoral bypass as a primary procedure when proper guidelines are used.