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An optimal inflow procedure for multi-segmental occlusive arterial disease: ilio-femoral versus aorto-bifemoral

G Zukauskas1, H Ulevicius, E Janusauskas

  • 1Department of Surgery, Mubarak Al-Kabeer Hospital, Hawaii, Kuwait.

Cardiovascular Surgery (London, England)
|August 15, 1998
PubMed

Insights

For chronic critical limb ischemia requiring multi-segmental reconstruction, unilateral ilio-femoral bypass offers outcomes comparable to aorto-bifemoral bypass, with reduced perioperative risks. Extra-anatomical bypasses demonstrate lower effectiveness.

Area of Science:

  • Vascular Surgery
  • Arterial Disease Management

Background:

  • Chronic critical limb ischemia (CLI) is a significant challenge in vascular surgery, often stemming from multi-segmental arterial disease.
  • While aorto-iliac artery correction suffices for many, 10-15% require multi-segmental reconstructions, necessitating optimal inflow procedures.

Purpose of the Study:

  • To retrospectively compare perioperative and long-term outcomes of different inflow procedures for multi-segmental lower limb revascularization.
  • The study evaluated aorto-bifemoral bypass, unilateral ilio-femoral bypass, and extra-anatomical bypass.

Main Methods:

  • A 10-year retrospective analysis (1984-1994) of 449 multi-segmental aorto-femoro-popliteal/tibial reconstructions for occlusive arterial disease.
  • Procedures included aorto-bifemoral (131 cases), unilateral ilio-femoral (288 cases), and extra-anatomical bypass (30 cases).

Main Results:

  • Postoperative mortality was lowest in the unilateral ilio-femoral group (1.3%) compared to aorto-bifemoral (3.8%) and extra-anatomical (3.3%) bypasses.
  • Five-year primary graft patency rates were 90.9% (aorto-bifemoral), 88.5% (unilateral ilio-femoral), and 66.7% (extra-anatomical).
  • Secondary patency rates at 5 years were 94.7%, 93.4%, and 77.3% for the respective groups.

Conclusions:

  • Unilateral ilio-femoral bypass is a highly effective inflow procedure for multi-level occlusive arterial disease, matching aorto-bifemoral bypass efficacy with improved safety.
  • Extra-anatomical bypasses are less effective for these complex cases.
Abstract

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