Extra-anatomical transobturator bypass, modifications of the technique 10 cases report and review of literature

Abstract

Context: Transobturator bypass may be a good alternative or a good solution in hostile groin either scared or infected with severe sepsis in drug addict patients. Aims: Evaluating the results transobturator bypasses in cases where groin cannot be addressed after 2 years follow-up. Settings and Design: This is a personal experience using transobturator bypass as an alternative management in a patient with either groin infection or scared groin in recurrent occluded grafts. Subjects and Methods: Ten cases in which transobturator bypass was performed; late graft occlusion was the indication in (five cases) while groin infection was the indication in the other (five cases). In all patients, common iliac - popliteal bypass was performed. In drug addict patients; infected groin, the tunnel was fashioned in a plane deep to the adductor muscles to be rather away from the infected areas, while in cases of graft occlusion, the much easier subcutaneous plane was chosen to allow easier surveillance of the graft. Results: Obturator bypass was performed in ten cases; five occluded grafts and five infected groin, four of them were addicts. One of the drug addicts presented with groin mass while three of them presented shocked and rupture infected pseudoaneurysm. One died of fulminant sepsis. Two years follow-up, seven grafts were patent. Only three experienced major amputations. Conclusions: The proper timing of the procedure, use of endarterectomy as well as the proper choice of the plane of the tunnel is considered essential prerequisites for a successful outcome.