Femorofemoral Bypass Graft Research Articles

Femorofemoral bypass with an infrascrotal perineal approach for the patient with an infected groin wound

A technique is presented for revascularization of patients having a groin wound infection, which minimizes the risk of recurrent graft infection. A femorofemoral bypass with a subcutaneous perineal tunnel is constructed farther from the infected groin wound than the standard subcutaneous suprapubic tunnel. The route of the graft appears to result in neither excessive tension on the graft when the leg is abducted nor kinking of the graft when the leg is adducted. Long-term follow-up will be needed to compare the patency of this route with the standard suprapubic tunnel in patients with an infected groin wound who require a femorofemoral bypass graft.

Femorofemoral bypass grafts: Ten-year experience

From August 1972 to September 1982, one of us (F.R.P.) performed 119 femorofemoral bypass grafts on 78 men and 35 women with an average age of 62 years. Axillofemorofemoral grafts were excluded. The 30-day operative mortality rate was 1.7% (2 of 119). The cumulative patency rates determined by the life-table method were 97.4% at 30 days, 95.1% at 1 year, 83.3% at 3 years, 72.2% at 5 years, and 55% from 6 through 10 years. There were no graft failures in the 21 patients followed up for more than 6 years. There were 21 grafts at risk at 7 years, 15 at 8 years, 10 at 9 years, and four at 10 years. Donor iliac arteries were judged to be acceptable by a combination of simple analyses including physical examination, noninvasive laboratory testing, angiography, and intraoperative direct blood pressure measurements. There was no evidence of a vascular steal in any of the postoperative patients. One patient required an inflow procedure 2 years following femorofemoral grafting. Two patients required resection of an abdominal aortic aneurysm 2 and 3 years, respectively, following femorofemoral grafting. There was one early graft failure secondary to infection, and five grafts became infected at 20, 29, 33, 46, and 62 months, respectively, following femorofemoral grafting. False aneurysm formation, diabetes, and trauma were significant factors in these infections. Initially only high-risk patients were selected as candidates for femorofemoral grafting. Because we were encouraged by the early success rate and the apparent durability of the method, the indications were broadened to include good-risk patients who met rigid criteria for femorofemoral grafting.

Femorofemoral bypass grafts: Ten-year experience

Femorofemoral bypass grafts: Ten-year experience

Mycotic Aneurysm of the External Iliac Artery Caused by Migration of a Total Hip Prosthesis

A 77-year-old patient had a mycotic aneurysm of the left external iliac artery secondary to migration of a total hip prosthesis. Symptoms included pain, numbness, decreased hip motion, and a temperature of 38.5 degrees. The left leg was shortened, externally rotated, and swollen. There was anterior thigh hypoesthesia and quadriceps paralysis. A pulsatile mass in the lower left quadrant of the abdomen emitted a thrill and a loud bruit. A preoperative arteriogram facilitated diagnosis and planning of surgery. A transpubic femorofemoral bypass graft was used to reroute blood to the left lower limb, avoiding vascular reconstruction in the area of the aneurysm, a suspected site of infection. A false aneurysm was determined and was then isolated. The prosthesis was removed. During this operation, the acetabular component was found freely mobile within the false aneurysm. Cultures of the removed vascular tissue grew Staphylococcus epidermidis. An arteriogram should be obtained prior to operation for any medial intrapelvic displacement of a total hip prosthesis to diagnose the extent of vascular involvement. Physical examination may not reveal the aneurysm, but signs of neuropathy or venous thrombosis may suggest this diagnosis.

The value of multiple-plane angiography in the assessment of aortoiliac disease.

Aortography, regarded as a definite diagnostic study in evaluating pateints with peripheral vascular occlusive disease, is usually done in the anteroposterior projection only. Occasionally, a significantly diseased area may not be identified on this projection, and an oblique view of the aortoiliac region may clarify the presence and severity of arteriosclerosis. At present, our indications for obtaining oblique views of the aortoiliac region are (1) when symptoms correlate poorly with the arteriographic findings in the anteroposterior projection, or (2) when the severity of the lesion is in doubt. These projections also are used to evaluate patients who have had previous aortoiliac bypass grafts and in whom ischemic symptoms recur. Patients with unilateral limb ischemia who are being considered for femorofemoral bypass graft procedures or iliac endarterectomy are also appropriate candidates, especially when radiopaque material overlies the vessels. Arteriograms in oblique projections also are recommended for more precise evaluation of the origin of the profunda femoris artery.

Axillofemoral and femorofemoral bypass grafts: safe surgical alternatives in aortoiliac occlusive disease.

Axillofemoral and femorofemoral bypass grafts: safe surgical alternatives in aortoiliac occlusive disease.

Crossover femoro-femoral bypass grafts.

Aortofemoral bypass is the operation we prefer in occlusive disease of the abdominal aorta and iliac arteries. The procedure is occasionally contraindicated by the patient's age, debility, or associated disease states. In such cases a less extensive bypass procedure may be of value. When the predominant lesion is a unilateral iliac artery obstruction, the opposite side being relatively normal, a crossover femoro-femoral bypass graft should be considered. We have used this form of bypass in this setting in poor risk patients with impending gangrene, rest pain, or early tissue compromise of a leg with gratifying results. The following reports describe six cases in which the operation was successful; the probable reasons for failure in two other cases are discussed. <h3>Report of Cases</h3> Case1.—A 79-year-old white man was admitted to University Hospital in November 1966 because of gangrene of the left great toe. He had had intermittent claudication for several

Suprapubic vascular graft--a warning.

To the Editor:— The femorofemoral bypass graft is an increasingly popular arterial shunt procedure. Such grafts traverse the suprapubic area subcutaneously and are therefore a potential hazard to the unsuspecting surgeon who may later undertake a lower abdominal, pelvic, or inguinal operation. A combined arteriogram and cystogram in one of our cases illustrates the relationship of graft and bladder (Fig 1). The subcutaneous interfemoral graft, described by Vetto 1 in 1962, is used to relieve ischemia due to unilateral iliac arteriosclerosis obliterans. The technique is particularly valuable in poor-risk patients who cannot tolerate major abdominal surgery. The graft, a prothesis or vein, is simply introduced from one groin incision to the other by subcutaneous tunneling, then anastomosed to each common femoral artery. No warning suprapubic scar is visible. The scheme of the interfemoral graft is depicted in Fig 2. A history of prior arterial surgery or bilateral femoral scars should