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Femorofemoral versus aortobifemoral bypass: outcome and hemodynamic results
J R Schneider1, S R Besso, D B Walsh
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon.
Insights
Femorofemoral bypass (FFB) shows lower graft patency and poorer hemodynamic function compared to aortobifemoral bypass (AFB). However, FFB remains a viable option for high-risk patients needing limb salvage.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Reconstructive Surgery
Background:
- Femorofemoral bypass (FFB) is an alternative to aortobifemoral bypass (AFB) for specific patient groups.
- Indications include high operative risk or unilateral iliac artery disease where AFB is deemed inappropriate.
- Understanding the comparative utility of FFB versus AFB is crucial for optimal patient selection.
Purpose of the Study:
- To compare the outcomes of femorofemoral bypass (FFB) and aortobifemoral bypass (AFB) in concurrent patient cohorts.
- To evaluate the appropriate use of FFB by analyzing patient characteristics and surgical results.
- To determine if FFB is a suitable alternative to AFB in selected cases.
Main Methods:
- Retrospective review of patients undergoing FFB or AFB between 1986 and 1991.
- Primary outcome measures included patient survival, graft patency, limb salvage, and hemodynamic performance.
- Subgroup analysis stratified patients by risk (low vs. high) and indication (claudication vs. limb threat).
Main Results:
- FFB patients were older with more comorbidities than AFB patients.
- Long-term graft patency was significantly lower for FFB (60% at 3 years) compared to AFB (85% at 3 years).
- Both procedures achieved limb salvage in over 85% of patients at 3 years; however, FFB showed inferior primary patency and hemodynamic performance in low-risk patients.
Conclusions:
- Femorofemoral bypass (FFB) is inferior to aortobifemoral bypass (AFB) in terms of graft patency and hemodynamic function.
- AFB should be the standard for low-risk patients with iliac occlusive disease.
- FFB provides adequate limb salvage and function for high-risk patients unsuitable for AFB.
Purpose:
Femorofemoral bypass (FFB) is used in selected patients when aortobifemoral bypass (AFB) is believed to be inappropriate because of high operative risk or predominantly unilateral iliac artery occlusive disease. We examined concurrent patients who underwent either FFB or AFB to better understand the appropriate use of FFB.
Methods:
The characteristics and outcomes of patients who underwent FFB and AFB during 1986 to 1991 at our institution were retrospectively reviewed. Primary measures of outcome included patient survival, graft patency, limb salvage, and hemodynamic performance of FFB and AFB. Further analysis was performed after substratification for low versus high risk and claudication versus limb threat as the indication for surgery.
Results:
FFB was performed in older patients with more medical comorbidities when compared with AFB. Long-term graft patency was inferior after FFB compared with AFB (60% vs 85% at 3 years, p < 0.01). However, both FFB and AFB achieved limb salvage in more than 85% of patients at 3 years. When patients at low risk undergoing nonemergency AFB were compared with patients at low risk who underwent FFB and who had no contraindication to AFB, FFB proved inferior to AFB as measured by graft patency (primary patency 61% vs 87% at 3 years, p < 0.03) and hemodynamic performance (predicted ankle-brachial index with perfect outflow 0.82 after FFB vs 1.03 after AFB). On the basis of a detailed analysis of patient and graft risk factors, we could not explain the inferior patency rate of FFB, although our analysis suggested that inadequate inflow may contribute.
Conclusions:
FFB is inferior to AFB as measured by patency and hemodynamic function. This inferior performance is independent of indications for FFB. AFB should remain the standard therapy for patients at low risk with iliac occlusive disease, but FFB provides adequate function and limb salvage in patients at high risk.