Crossover Bypass Research Articles

Transpopliteal stenting of femoral occlusions in patients with critical limb ischemia using a 4-French system.

In many patients with critical limb ischemia (CLI), transfemoral endovascular recanalization is the preferred treatment. Transpopliteal treatment may be used in patients with inaccessible groins. This retrospective study regards transpopliteal stenting of superficial femoral artery (SFA) occlusions using a 4F system. Eleven patients (4 male and 7 female [mean age 77years]) underwent 12 attempts of transpopliteal recanalization of long SFA occlusions (Trans-Atlantic InterSociety Consensus B through D). All patients had CLI (Rutherford 4 to 6) and were nonoperable due to poor general condition. Indications for transpopliteal access were proximal/flush SFA occlusions (n=5), failure of antegrade recanalization (n=4), infected femoral-femoral crossover bypass (n=2), and occlusion of both the native SFA and the femoral-popliteal bypass (n=1). The popliteal artery was punctured under ultrasound guidance. Occlusions were recanalized subintimally, and 4F compatible stents were implanted. Technical success rate (<30% residual stenosis) was achieved in 83% of cases. In two patients, stent dislocation occurred while the sheath was removed. One arteriovenous fistula was successfully treated with additional stenting. During 6-month follow-up, there were no major amputations, and three patients died from nonrelated causes. Fifty percent of patients alive after 6months improved to Rutherford score ≤3. The duplex restenosis (>50%) rate at 6months was 50%. Transpopliteal primary stenting of complex SFA lesions in CLI for a temporary bypass is now technically feasible using a 4F system. Technical results are promising. Clinical results after 6months are acceptable when taking into consideration that this approach may be the last option for limb salvage.

Fatal early peripheral post‐reperfusion syndrome and the role of cutaneous signs

The purpose of this report is to present the case of a 75-year-old male affected by right common femoral artery and abdominal aortic aneurysms. His clinical history was also characterised by post-ischaemic cardiomyopathy, arterial hypertension, chronic respiratory disease and peripheral arterial disease. We performed two surgical procedures: right femoral aneurysmectomy and femoro-femoral bypass and subsequently a femoro-femoral crossover bypass plus right femoro-popliteal bypass below the knee. The second operation became necessary in order to treat acute occlusion of the right iliac-femoral arterial axis. The patient developed a progressive and aggressive lower limb post-perfusion syndrome associated to frank peripheral oedema, myocardial stunning, reperfusion arrhythmias, renal failure and respiratory distress. Cutaneous alterations (oedema of the leg, mottled skin and cyanosis of the foot) were more specific compared with Doppler ultrasound that showed the presence of adequate blood flow in the early phase. On the basis of this experience and of pertinent literature, this study represents a challenge for the understanding of the exact mechanism of origin and progression of post-reperfusion syndrome.

Treatment of aortoiliac occlusive or dilatative disease concomitant with kidney transplantation: how and when?

Background and PurposeAortoiliac (AI) lesions (both dilatative and occlusive) can occur in kidney allograft recipients. The correct timing of vascular imaging and treatment is controversial. Aim of the present paper is to report our experience. Methodsbetween January 2010 and December 2012, 106 patients included in our waiting list for kidney transplant underwent computed tomography (CT) angiogram to study AI axis. In 21 cases an AI lesion was identified before transplant. In 3 cases surgery was mandatory before kidney transplant, and in 18 cases lesions were treated simultaneously with kidney transplantation. Main findingsAI pathology distribution was as follows: 15 iliac stenoses treated with thromboendarterectomy (TEA), 2 Leriche syndrome and 1 aortic aneurism treated with an aortobisiliac bypass (AI-BP), and 3 aneurysms treated with endovascular aortic repair (EVAR). In two cases a postoperative hematoma occurred. In one case occlusion of a stent-graft branch was treated with a femoro-femoral crossover bypass and transplant was then performed on the contralateral iliac axis. Perioperative mortality was 0%, and graft survival rate was 100% at 1 year in all cases. ConclusionsA CT angiogram is useful in order to detect AI lesions and to be able to evaluate the best treatment option for the kidney transplantation and the correct timing for additional vascular surgery. The EVAR procedure should be safe, and does not compromise anastomosis success and graft survival, with less postoperative complications than open surgery.

Blood will find its way. Retrograde perfusion of a transplant- kidney via a femoro- femoral crossover bypass

Case reportBlood will find its way. Retrograde perfusion of a transplant- kidney via a femoro- femoral crossover bypassJurgen Knuth, Dirk Wenzel, Axel Goßmann, and Marko AleksicJurgen Knuth Department of Abdominal, Vascular and Transplant Surgery, Witten/Herdecke University, Medical Center Cologne-Merheim, Köln, Germany Search for more papers by this author, Dirk Wenzel Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Center Cologne-Merheim, Germany Search for more papers by this author, Axel Goßmann Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Center Cologne-Merheim, Germany Search for more papers by this author, and Marko Aleksic Department of Abdominal, Vascular and Transplant Surgery, Witten/Herdecke University, Medical Center Cologne-Merheim, Köln, Germany Search for more papers by this authorPublished Online:November 12, 2013https://doi.org/10.1024/0301-1526/a000316PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byRenal Transplant Artery Inflow Stenosis Treated with Femorofemoral Bypass16 May 2020 | International Journal of Angiology, Vol. 30, No. 04Femoro-femoral Bypass for Graft Salvage in a Renal Transplant Patient With Aorto-iliac Occlusion: A Case ReportTransplantation Proceedings, Vol. 47, No. 5 Volume 42Issue 6November 2013ISSN: 0301-1526eISSN: 1664-2872 InformationVasa (2013), 42, pp. 453-456 https://doi.org/10.1024/0301-1526/a000316.© 2013Hogrefe AGPDF download

Sapheno-femoral crossover venous bypass in a case of deep vein thrombosis: an uncommonly done procedure for a very common disease

Vascular bypass procedures using saphenous vein graft are commonly done in cases of peripheral vascular disease, however in cases of venous disease the use of vascular bypass is limited , even though reports in literature show good results with resolution of symptoms in majority of patients. A review of the results of deep vein reconstruction for obstructive disease reveals the clear ability to perform these procedures with the minimum of risk, and the results in the successful cases demonstrate the improvement that follows correction of the physiologic abnormalities of obstruction [1]. Management of venous obstruction seems to be a bit neglected as far as surgical management is concerned with anticoagulants playing the major role. The procedures used in management of unilateral iliofemoral thrombosis are Palma’s procedure (cross-over femoro-femoral venous bypass using saphenous vein from contralateral thigh), use of prosthetic conduits and endovascular interventions. Deep Vein Thrombosis (DVT) is a very common disease with acute presentation of sudden onset edema, difficulty in walking and severe pain in the leg. Initial management is usually with anticoagulants and thrombolysis, with very few patients undergoing embolectomy. Medical management in the acute phase mostly leads to partial recannalization. After resolution of symptoms partially, the chronic phase sets in where patients continue to have edema, develop pigmentation, varicose veins and decreased work performance. Virchow’s triad of stasis, hypercoagulability and injury to vessel wall are important in the pathogenesis and management of the disease. Cross-over femoral venous bypass is suitable for persistent isolated unilateral iliac or common femoral vein occlusions in young and middle aged patients with severe chronic deep venous insufficiency unresponsive to conservative measures [2]. This case is reported to highlight the benefit and good results of vascular bypass in venous obstructions where facility for endovascular procedures is not available.

Our surgical procedure in acut thrombosis of stent graft using in treatment of pseudoaneurysm developing in popliteal anastomosis region of previous cross-over composite sequential femoro-popliteal bypass

Methods A 66-year-old man was admitted to our hospital on November 11, 2012. He had a painful, pulseless, and cold below-knee in right lower extremity. He had previous right cross-over composite sequential femoropopliteal bypass. Angiography showed acute occlusion of cross-over composite femoro-popliteal bypass graft and stent graft used in treatment of pseudoaneurysm developing in popliteal anastomosis region of this graft. Proximal EPTFE graft was occluded with thrombus in arteriography.

Late cerebrospinal fluid drainage for paraplegia developed following Bentall procedure for acute type a aortic dissection

Methods A 51 year old woman who had chest and back pain and syncope, was admitted to emergency department. Thorax CT revealed acute type A aortic dissection and she underwent emergency surgery. Modified Bentall procedure along with hemiarch replacement was performed using antegrade selective cerebral perfusion. The next day she developed cardiac tamponade and ischemia of the left leg. Re-exploration did not reveal any active bleeding source and right-to-left femoro-femoral crossover bypass was performed with a 10 mm dacron graft during repeat sternotomy. Distal pulses were palpable for both legs after the procedure. On third postoperative day she required a second re-exploration for bleeding and tamponade. Due to hemodynamic instability she received inotropes, required prolonged sedation and dialysis. On postoperative day 5, sedation was terminated and she was extubated but her physical examination revealed paraplegia. Medical theraphy was started. CSF drainage was performed afterwards.

English

At bedside ultrasound, the mass resulted to have fluid content, with an active flow, confirmed by colour Doppler. A contrast-enhanced computed tomography scan was performed, showing a large pelvic haematoma with the femorofemoral graft within. The patient was urgently brought to the operatory room. The hematoma was evacuated, and a new bypass graft was placed. Conclusion Bedside ultrasound made it possible to recognize the fluid nature of a large slowly growing abdominal mass that resulted to be the consequence of the detachment of the distal end of a Femorofemoral crossover bypass, and thus to address and speed up diagnostic workout and treatment.

Large Aortic Pseudoaneurysm and Subsequent Spondylodiscitis as a Complication of Endovascular Treatment of Iliac Arteries

Both aortic pseudoaneurysm following endovascular aortoiliac reconstruction and spondylodiscitis subsequent to endograft infections are rare complications. We present a case of aortic false aneurysm following iliac arteries treatment complicated by spondylodiscitis after its endovascular repair. In this patient, a huge aortic pseudoaneurysm was diagnosed and treated in an emergency setting a few days after the procedure. A left aortomonoiliac endograft was placed and a femoro-femoral crossover bypass was performed. Afterward, the patient developed a stent graft infection and a lumbar spondylodiscitis. The patient was managed with a conservative treatment and, after 4 years, he continues to live. Analyzing this case, we would like to point out the following aspects: any procedure, although well established and technically simple, can cause life-threatening complications; hematomas resulting from endovascular exclusion of large pseudoaneurysms could be drained, to prevent bacterial infections.

Perioperative Evaluation of Iliac ZBIS Branch Devices: A French Multicenter Study

The purpose of this study was to evaluate short-term results of endovascular treatment of common iliac artery (CIA) aneurysms without a distal neck by using iliac branch devices (IBDs), which enable maintenance of antegrade perfusion to the internal iliac artery(IIA). Our investigation was done in a prospective, multicenter, nonrandomized manner. IBD were implanted to exclude CIA aneurysms with a diameter >25 mm in patients unfit for open repair. The stent grafts were designed based on preoperative angio-CT findings. A covered stent implantation between the IBD and the target IIA was performed during the same surgical procedure. Angio-CT was performed within the 30 days after the procedure. From January 2009 to April 2010, 39 patients were included in our study (38 men and 1 woman, mean age 73 years). The CIA aneurysm (mean diameter 32.3 mm) was isolated in 15 patients and associated with an abdominal aorta aneurysm (mean diameter 66 mm) in 24 patients. The IBD was systematically connected to a bifurcated aortobiiliac stent graft. The bifurcated stent graft was implanted during the same procedure in all patients, except for two who had a bifurcated stent graft history. Median surgery time, fluoroscopy time, and volume of contrast product were 192 (range 90-360) minutes, 32 (10-120) minutes, and 150 (60-352) mL, respectively. In 37 patients (95%), the internal iliac branch was patent at the end of the surgery. In two patients (5%), it was occluded, entailing a subischemic colic episode and buttock claudication in one of them. To treat a type I endoleak, a proximal extension partially covering a renal artery was implanted during the same surgery. A type III endoleak was diagnosed on the postoperative angio-CT. In three patients, a cross-over femorofemoral bypass was performed for an external iliac leg thrombosis (and for an internal iliac branch thrombosis in one case). In all, at 30 days, no death was reported and the success rate was 90% (three leg stenoses and a type III endoleak). IBD implantation to maintain an antegrade internal iliac perfusion is possible and has shown promising early success. Our results can be compared with those in the published literature. A learning curve will be needed to improve the technical success rate.

Long-term graft occlusion in aortobifemoral position

Aortobifemoral (AFF) bypass is still the most common surgical procedure used in treatment of aortoiliac occlusive disease. One of the most common complications of AFF bypass procedure is long-term graft oclussion. The aim of this study was to determine the cause of long-term graft occlusion in AFF position, as well as the results of early treatment of this complication. This retrospective study, performed at the Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade, involved 100 patients treated for long-term occlusion of bifurcated Dacron graft which was ensued at least one year after the primary surgical pro cedure. The most common cause of the long-term graft occlusion was the process at the level of distal anastomosis or below it (Z = 3.8, p = 0.0001). End-to-end type of proximal anastomosis has been associated with a significantly increased rate of long-term graft occlusion (Z = 2.2, p = 0.0278). Five different procedures were used for the treatment of long-term graft occlusion: thrombectomy and distal anastomosis patch plasty (46% of the cases); thrombectomy and elongation (26% of the cases); thrombectomy and femoropopliteal bypass (24% of the cases); crossover bypass (2% of the cases) and a new AFF bypass (2% of the cases). The primary early graft patency was 87%. All 13 early occlusions occurred after the thrombectomy associated with patch plasty of distal anastomosis. Thrombectomy with distal anastomosis patch plasty showed a statistically highest percentage of failures in comparison to thrombectomy with graft elongation, or thrombectomy with femoro-popliteal bypass (Z = 2 984, p = 0.0028). Redo procedures were performed in all the cases of early occlusions. In a 30-day follow-up period after the secondary surgery, 90 (90%) patients had their limbs saved, and above knee amputation was made in 10 (10%) patients. Long-term AFF bypass patency can be obtained by proximal end-to-end anastomosis on the juxtarenal part of aorta and distal anastomosis on the bifurcation of the common femoral, or on the deep femoral artery.

Axillary artery crossover bypass for a patient with coronary subclavian steal syndrome developing acute heart failure

Axillary artery crossover bypass for a patient with coronary subclavian steal syndrome developing acute heart failure

Collective Therapy and Therapeutic Strategy for Critical Limb Ischemia

To determine a treatment strategy based on the outcomes of various previous interventions for critical limb ischemia in arteriosclerosis obliterans (ASO). We examined outcomes of 292 ASO patients who had had critical limb ischemia between May 1995 and July 2009. Patients underwent the following procedures in 167 cases: aortofemoral bypass (n = 14), femorofemoral crossover bypass (n = 29), femoropopliteal bypass (n = 104) and femorotibial bypass (n = 40). Other procedures included bypass only (n = 147), bypass combined with thromboendarterectomy (n = 10), bypass combined with endovascular therapy (n = 6), bypass combined with lumbar sympathectomy (n = 2), endovascular therapy combined with thromboendarterectomy (n = 4), endovascular therapy (n = 19), lumbar sympathectomy (n = 6), conservative therapy (n = 65), and major amputation (n = 31). We also calculated P3 risk scores and measured transcutaneous oxygen pressure (tcPO2) and skin perfusion pressure (SPP) before and after therapy. The limb salvage rate was 87% at 2 years in the arterial reconstruction group. In the low-risk group (a P 3 risk score of 3), the 1-year amputation-free survival rate was 96%. In the medium-risk group (a P 3 risk score of 4-7), the 1-year amputation-free survival rate was 88%. In the high-risk group (a P 3 risk score of 8), the 1-year amputation-free survival rate was 66%. The hospital death rate in the arterial reconstruction group was 3.2%, all of whom were patients who underwent bypass. The survival rate at 5 years was 65% and 36% in the conservative therapy only group. Ulcers healed in 140 out of 144 patients. The 4 patients with unhealed infections had tcPO2 or SPP values of more than 30 mmHg after treatment. Major amputations were performed in 4 of 5 patients who had tcPO2 or SPP values from 20 to 30 mmHg after treatment. Major amputations were performed in all 6 patients who had tcPO2 or SPP values of less than 20 mmHg after treatment. In cases with tcPO2 or SPP values of more than 30 mmHg, an ulcer will probably heal, except in infected cases. We suggest that, if these values are less than 30 mmHg, complete revascularization should be performed. The P3 risk score was useful in predicting limb salvage in the current series. Hybrid therapy in bypass and endovascular therapy must be performed in cases where patients are in a generally poor condition. It is important to attempt amelioration in limb salvage and to control the operative mortality rate with sufficient perioperative control. (English Translation of Jpn J Vasc Surg 2011;20:905-911).

Endovascular aneurysm repair using the periscope graft technique for thoracic aortic anastomotic pseudoaneurysm

Replacement of an artificial graft in a redo lateral thoracotomy is extremely difficult with a high risk of lung injury. Endovascular intervention may be an ideal option in such conditions, as in the following case. A 75-year old man with a history of coronary artery bypass graft surgery developed a proximal anastomotic pseudoaneurysm 1 year after undergoing artificial proximal descending aorta replacement surgery. Thoracic endovascular aneurysm repair was performed successfully using the periscope graft technique to preserve the flow into the left subclavian artery from the distal side of the aortic stent graft. Since the patient had coronary artery bypass grafting, debranching of the left subclavian artery was considered too risky. Using the periscope graft technique, the pseudoaneurysm was successfully repaired preserving the left subclavian artery patency, thus obviating a side-to-side subclavian artery crossover bypass.

Influence of atheromatous lesions in the ilio-femoral segment on the occurrence of stentgraft thrombosis after endovascular treatment of an abdominal aortic aneurysm.

Limb graft thrombosis (LGT) is one of the most frequent severe complications after endovascular repair of abdominal aortic aneurysms. The aim of the study was to assess the influence of atherosclerosis in ileo-femoral segment on the incidence of LGT as well as to analyze the methods of treatment of LGT. The medical records of 564 consecutive patients operated endovascularly for abdominal aortic aneurysm by means of bifurcated stentgrafts in the Department of General, Vascular and Transplantat Surgery of Medical University of Warsaw were analyzed. The minimal observation time after surgery was one year. Patients with inflammatory, ruptured and falls aneurysms as well as those with the observation period below 12 months were excluded from the study. Patients were divided into two groups: test (B) and control (K) depending on the progression of atherosclerosis in the iliac arteries. Group B included 184 patients (13 women and 171 men), with advanced atherosclerotic lesions of ilio-femoral segment, corresponding to the A - C class in the TASC classification. The remaining 380 patients (25 women and 355 men) without significant blood flow disorders in the iliac arteries, constituted the group K. The computed tomography was done in all patients with acute limb ischemia. During the observation time up to 114 month, the LGT occurred in 43 (7.6%) cases: [group B - 34/184 (18.5%), group K - 9/380 (2.4%)]. The treatment of LGT included an attempt of patency restoring of the prosthesis by means of thrombolysis or thrombectomy combined with stenting. In case of failure the cross-over femoro-femoral bypass was implanted. Thrombectomy was successful in 21 of 40 cases (52.5%), the local thrombolysis was done in 5 patients and it was successful in three cases and in the remaining two patients the thrombectomy was done. In 16 of 24 patients after patency restoring of the prosthesis the angioplastics and stenting was done. In 17 cases the femoro-femoral bypass was implanted. The atherosclerosis in ileo-femoral segment significantly increases the risk of LGT. An attempt of patency restoring (thrombectomia or thrombolysis) combined with stenting and cross-over femoro- femoral bypass implantation in case of failure seems to be the successful method of LGT treatment.

Crossover ilio-iliac bypass and removal of femoro-femoral graft as first treatment for the infection of crossover bypass in aortouniiliac endovascular aneurysm repair

The crossover femoro-femoral bypass, classically used for the treatment of unilateral iliac arterial obstruction, has recently become an integral part of aorto-uni-iliac endovascular aneurysm repair. We therefore, reconsider the therapeutic problems related to thrombosis and in particular to infection of the femoro-femoral prosthesis, when many attempts have been made to preserve the bypass and treat the infection. Showing a case treated and well eight months later, we put forward the old technique of crossover ilio-iliac bypass, followed by the removal of the infected femoro-femoral graft. In our opinion, this technique circumvents the need for autologous tissue and allows for the use of prosthetics in a new, sterile, uncontaminated field. As this approach for these cases has so far not been reported in the literature, further cases and long-term follow-up are needed.

Endovascular Repair of a Streptococcus pneumonia-Induced Aortitis Complicated by an Iliacocaval Fistula

To describe the successful endovascular treatment and follow-up of a patient with a Streptococcus pneumonia-induced right iliacocaval fistula. A 82-year-old man was diagnosed with a right iliacocaval fistula, as a result of Streptococcus pneumoniae infection of the distal aorta and proximal right common iliac artery. After antibiotic treatment, he was initially unsuccessfully treated with balloon expandable covered stents. Then, the fistula was excluded by an aortamonoiliac endograft to the left common iliac artery, and occluders in the distal and proximal right common iliac artery followed by a femoral-femoral crossover bypass. Postoperatively patient was treated with prolonged antibiotics. After a follow-up of 20 months, there are no signs of active infection, endoleak, or fistula, both clinically and on 2-deoxy-2-[F18]fluoro-D-glucose positron emission tomography/computed tomography. In selected patients, complicated infectious disease of the aorto-iliac tract may be treated successfully with an endograft and prolonged antibiotics.

Arterial Thrombosis After Surgery of Pelvic Side Wall Recurrence of a Villoglandular Adenocarcinoma of the Cervix

Abstract Background: Villoglandular adenocarcinoma of the cervix is a rare condition that appears in young women and is characterized by its low aggressiveness. The most common treatment is surgery, consisting of either a conization or hysterectomy. Ovaries may be preserved depending upon the patient's reproductive desires. Case: The case reported here involves the recurrence of a stage IB1 villoglandular adenocarcinoma of the cervix. This may be the first case report of the recurrence of a villoglandular adenocarcinoma of the cervix with no lymph node metastasis following a radical hysterectomy, and the first case of a laterally extended endopelvic resection being complicated by an arterial thrombosis. Results: Resection was performed, leaving part of the residual tumor. The patient experienced a postoperative thrombosis of the left common iliac artery. A fasciotomy of the tibia and calf was performed, followed by a femoro-femoral crossover bypass. The patient is still undergoing rehabilitation, as well ...

Treatment of long-segment iliofemoral occlusive disease: two extra-anatomic bypass surgeries

To report and evaluate the clinical results of surgical treatment for long-segment iliofemoral arteriosclerosis obliterans, including external iliac-popliteal (EIP) and femoral-deep femoral (FDF) crossover bypass surgeries. From July 1995 to December 2009, 85 patients (61 male, 24 female, aged from 64 to 91 years, mean age 75 years) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were involved in this research. According to Fontaine classification, the 85 patients could be graded as 62 class IIb-III patients (72.9%), and 23 class IV patients (27.1%). In CT angiography or DSA examinations, the 85 patients were grouped into EIP (n = 49) and FDF (n = 36) surgical groups on the basis of visualizations in the affected deep femoral, supra-knee/infra-knee popliteal arteries. The healing time of ulcers and toe amputation wound, ankle-brachial index, and blood flow velocity in the affected limb together with accumulative patency rates in 1, 3 and 5 years and limb salvage rates in 3 and 5 years were analyzed. None of the 85 patients died or had extremity amputated in perioperatively. Seventy-four patients (87.1%) had been followed up from 2 to 13 years (mean 5.7 years). Postoperative ankle-brachial index of FDF and EIP groups was 0.55 ± 0.11, and 0.94 ± 0.13 (t = -21.88, P = 0.000). Postoperative velocity of popliteal artery blood flow in FDF and EIP groups was (32 ± 9) cm/s, and (48 ± 4) cm/s (t = 16.76, P = 0.000); velocity of anterior or posterior tibial artery was (22 ± 7) cm/s, and (42 ± 4) cm/s (t = 10.50, P = 0.000). The primary and secondary patency rates of FDF and EIP groups were 87.8% and 88.3%, 80.7% and 81.2%, 68.4% and 57.4% at 1, 3 and 5 years, respectively. Limb salvage rates of FDF and EIP groups were 87.6% and 88.6%, 76.7% and 71.3%, at 3 and 5 years, respectively. There were no statistically significant differences in 1, 3, and 5 years' cumulative secondary patency rate and limb salvage rate between FDF and EIP groups. As extra-anatomic bypass surgeries, FDF and EIP are both determined to be alternative procedures for unilateral common iliac-superficial femoral artery occlusive disease, especially suitable for high-risk patients. EIP group patients have better clinical outcomes than those in FDF group.

Salvage of infected vascular graft via ‘perivascular venous banding’ technique coupled with rectus abdominis myocutaneous muscle flap transposition

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro - femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this 'high-grade' vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, 'perivascular venous banding' technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections.