[Extra-anatomical femorofemoral crossover bypass grafting].

Abstract

The article summarizes the experience with extra-anatomical crossover femorofemoral bypass in correction of chronic critical and acute ischemia, as well as other complicated clinical situations, assessing both immediate and remote results.

Objective: The purpose of the study was to evaluate efficacy and feasibility of extra-anatomical femorofemoral crossover bypass at the present-day stage of the development of vascular surgery.

Patients and methods: Our single-centre study included a total of 33 patients with chronic and acute impairments of blood flow through the aortofemoral segment, in whom for various reasons it was impossible to use direct revascularization or endovascular intervention. The choice in favour of less traumatic extra-anatomical bypass grafting was made due to severity of concomitant pathology associated with an extremely high risk of aortofemoral bypass grafting. In all these patients, the character of lesions of the arterial bed did not allow us to perform endovascular correction (TASC II type C and D lesions). The main arterial blood flow was restored by extra-anatomical crossover femorofemoral bypass grafting.

Results: A favourable clinical outcome was achieved in 30 (91%) patients, with limbs saved. Four (12%) patients developed complications in the early postoperative period. Two (6%) patients died of infarction and sepsis. However, both interventions were performed for infectious complications, preceding aortoiliac-femoral reconstructions. We followed up for 5 years the fate of 22 (73%) of 30 patients discharged with limbs saved. Of these, five patients died of progressing concomitant pathology, acute cardiac events, with the crossover graft's function preserved. Four patients were found to have thromboses, making it necessary to perform amputations in 3 cases. The 5-year primary patency of grafts amounted to 73.9%.

Conclusion: Extra-anatomical femorofemoral crossover bypass is an effective method of revascularization. Technical capabilities of such type of reconstruction appear appropriate in impaired blood flow through one of the iliac arteries with preserved adequate patency of the aorta and contralateral side and impossibility to perform a direct revascularizing operation or roentgenoendovascular correction. In some cases, especially in patients with limited life expectancy, this operation may be a method of choice.