Related Experiment Videos
Femorofemoral bypass for aortofemoral graft limb occlusion: a ten-year experience
K D Nolan1, M E Benjamin, T J Murphy
1Department of Surgery, Northwestern University Medical School, Chicago, Illinois.
Insights
Femorofemoral bypass (FFB) is a safe and durable treatment for aortofemoral bypass (AFB) limb occlusion. Aggressive reoperation significantly improves graft function and limb salvage rates.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Arterial Bypass Grafting
Background:
- Aortofemoral bypass (AFB) is a common vascular reconstruction.
- Graft limb occlusion occurs in 10-20% of AFB patients, leading to limb ischemia.
- Femorofemoral bypass (FFB) is a debated treatment for AFB limb occlusion.
Purpose of the Study:
- To evaluate the durability and performance of femorofemoral bypass (FFB) for aortofemoral bypass (AFB) limb occlusion.
- To assess FFB graft patency and limb salvage rates in patients with AFB limb failure.
Main Methods:
- Retrospective review of 22 patients undergoing FFB for AFB limb occlusion between 1982 and 1992.
- FFB originated from the contralateral patent AFB limb.
- Distal anastomosis to common femoral or profunda femoris artery.
- Follow-up via Doppler arterial examination for a mean of 47 months.
Main Results:
- Cumulative 5-year primary patency rate of FFB was 54%.
- Secondary patency rate reached 84% at 5 years with reoperation.
- Limb salvage rate was 84% at 5 years, with only three major amputations.
- No perioperative deaths; 5-year survival rate was 77%.
Conclusions:
- FFB is a safe and durable option for treating AFB limb failure.
- An aggressive reoperation strategy enhances FFB graft function and limb salvage.
- FFB offers a viable solution for managing complications of aortofemoral bypass.
Purpose:
Aortofemoral bypass (AFB) is a durable reconstruction; however, graft limb occlusion occurs in 10% to 20% of patients and results in limb ischemia. Treatment of AFB limb occlusion has been debated, but many recommended femorofemoral bypass (FFB). FFB grafts have had excellent patency rates. The durability of FFB specifically for AFB limb occlusion has not been reported. This study retrospectively examined a 10-year experience with FFB for AFB limb occlusion to determine FFB performance.
Methods:
Between 1982 and 1992, FFB was performed on occluded AFB limbs in 22 patients (14 men and 8 women). Reoperation was performed for disabling claudication in five cases, but the remaining 17 patients (77%) had critical limb ischemia. FFB originated from the contralateral patent AFB limb in all cases. Distal anastomosis was to the common femoral artery (n = 8) or the profunda femoris (n = 14). FFB graft patency was confirmed by direct Doppler arterial examination over a mean follow-up of 47 months.
Results:
The cumulative life-table primary patency rate of FFB was 54% at 5 years. Reoperative procedures performed in nine cases resulted in a secondary patency rate of 84% at 5 years. The limb salvage rate was also 84% at 5 years, reflecting the impact of successful reoperation. Major amputations (two below-knee, one above-knee) were necessary in only three cases. There were no perioperative deaths after FFB, and the cumulative 5-year survival rate was 77%.
Conclusion:
Aortic graft limb occlusion occurs less frequently than failure of infrainguinal grafts making the success of specific reoperative strategies difficult to document reliably. This study suggests that FFB is a safe and durable alternative for AFB limb failure. An aggressive policy of reoperation has resulted in successful extension of FFB graft function and an excellent rate of limb salvage.