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A Comparative Evaluation of Femorofemoral Crossover Bypass and Iliofemoral Bypass for Unilateral Iliac Artery Occlusive Disease

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Jamal J. Hoballah, MD, FACS

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Claudio Jacobovicz, MD

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Chittur R. Mohan, MD

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Mario Martinasevic, MD

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Stephen M. Ryan, MD

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

William J. Sharp, MD, FACS

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Timothy F. Kresowik, MD, FACS

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

John D. Corson, MB, ChB, FRCS (Eng), FACS

Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

The purpose of this study was to compare the results of extra-anatomic femorofemoral crossover bypass grafting to the anatomic iliofemoral bypass grafting procedure in the treatment of patients with unilateral iliac artery occlusive disease with respect to patency and limb salvage.

The records of all patients with unilateral iliac artery disease who underwent revas cularization between January 1988 and December 1995 at the University of Iowa Hospitals and Clinics (UIHC) were retrospectively reviewed; 108 patients were identified and divided into two groups. Group I (n=68; male/female=44/24) was composed of all patients who underwent a femorofemoral crossover extra-anatomic bypass. All patients who underwent an iliofemoral anatomic bypass constituted group II (n=40; male/female=24/16). The mean age for group I was 60 years (range 28-87) and for group II, 54 years (range 14-86). The medical risk factors between both groups were comparable. Except for the higher incidence of gangrene in group II the indications for surgery were comparable between both groups. (continued on next page)

A polytetrafluoroethylene graft was used in 88% of group I patients and in 90% of group II patients (NS). In the remaining patients, an autogenous vein conduit was used. Two patients from group I (2.9%) died in the perioperative period (NS). Graft patency was assessed by clinical evaluation, Doppler-derived ankle/brachial indices, and color duplex imaging. The cumulative primary and secondary patency rates, limb salvage, and patient survival were calculated by use of life table analysis (SE<0.1). The need for simultaneous outflow and inflow procedures at the time of surgery was comparable between both groups. The proportion of patients who underwent further revasculariza tion during follow-up was also comparable. The 5-year primary and secondary graft patency rates were 81.7% and 90.3%, in group I and 61.3% and 80.5% in group II. Although the difference between both groups was not significant there was a tendency toward higher rates with femorofemoral bypass. The 5-year survival rates of 80.3% for group I and 73.3% for group II were comparable.

These data suggest that there is no significant difference in the long-term results between the femorofemoral crossover bypass grafts and iliofemoral grafts. Both procedures result in acceptable patency and limb salvage rates. The femorofemoral bypass is, however, more attractive, for it can be performed under local anesthesia if needed and does not involve the creation of the retroperitoneal incision necessary with the iliofemoral bypass.

Angiology, Vol. 49, No. 4, 259-265 (1998)
DOI: 10.1177/000331979804900403


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