Femorofemoral (Femoral-Femoral) Bypass
No Results
No Results
processing….
Femorofemoral (femoral-femoral) bypass is a method of surgical revascularization used in the setting of unilateral common and/or external iliac artery occlusive disease. The technique is dependent upon a patent iliac arterial system without hemodynamically significant disease to supply adequate inflow of blood to both lower extremities. It is a commonly used means of extra-anatomic vascular reconstruction for patients with disabling claudication or critical limb ischemia (CLI) in whom underlying anatomic constraints rule out endovascular means of restoring in-line flow and those who do not qualify for anatomic reconstruction because of comorbidities that preclude a more invasive open approach.
Femorofemoral bypass may also be used as a component of endovascular repair of abdominal aortic aneurysms (AAAs), whereupon one aortoiliac system is occluded on an emergency or elective basis to ensure exclusion of the aortic aneurysm. Primary patency rates of femorofemoral bypasses are estimated to be in the range of 65-70% at 5 years. [1, 2, 3] The bypass patency rates, however, are inferior to in-line reconstruction benchmarks set by the aortofemoral and iliofemoral bypass operations.
Indications for femorofemoral bypass are as follows:
In a retrospective study of 82 consecutive patients with CLI from unilateral iliofemoral artery occlusion, Ma et al found that femorofemoral bypass to the deep femoral artery appeared to be safe, durable, and effective for limb salvage after attempted percutaneous endovascular intervention had failed. [4]
Contraindications for femorofemoral bypass are as follows:
The inflow aortoiliac arterial system must be thoroughly preoperatively assessed. The outflow common, superficial, or deep femoral artery must be thoroughly assessed as well.
Strict attention to sterile technique should be used when handling prosthetic grafts. A wide sterile field is necessary to manage intraoperative bleeding or other unexpected complications that can arise while performing the procedure.
The geometry of the graft tunneling should be carefully assessed; the graft should be in an inverted C (or gentle S) configuration to prevent undue tension and kinking at the anastomoses.
Mingoli A, Sapienza P, Feldhaus RJ, Di Marzo L, Burchi C, Cavallaro A. Femorofemoral bypass grafts: Factors influencing long-term patency rate and outcome. Surgery. 2001 Apr. 129(4):451-8. [Medline].
Devolfe C, Adeleine P, Henrie M, Violet F, Descotes J. Ilio-femoral and femoro-femoral crossover grafting. Analysis of an 11-year experience. J Cardiovasc Surg (Torino). 1983 Nov-Dec. 24(6):634-40. [Medline].
Pai M, Handa A, Hands L, Collin J. Femoro-femoral arterial bypass is an effective and durable treatment for symptomatic unilateral iliac artery occlusion. Ann R Coll Surg Engl. 2003 Mar. 85(2):88-90. [Medline].
Ma T, Ma J. Femorofemoral bypass to the deep femoral artery for limb salvage after prior failed percutaneous endovascular intervention. Ann Vasc Surg. 2014 Aug. 28 (6):1463-8. [Medline].
Huded CP, Goodney PP, Powell RJ, Nolan BW, Rzucidlo EM, Simone ST, et al. The impact of adjunctive iliac stenting on femoral-femoral bypass in contemporary practice. J Vasc Surg. 2012 Mar. 55(3):739-45; discussion 744-5. [Medline]. [Full Text].
Kim YW, Lee JH, Kim HG, Huh S. Factors affecting the long-term patency of crossover femorofemoral bypass graft. Eur J Vasc Endovasc Surg. 2005 Oct. 30(4):376-80. [Medline].
Stone PA, Armstrong PA, Bandyk DF, Keeling WB, Flaherty SK, Shames ML. Duplex ultrasound criteria for femorofemoral bypass revision. J Vasc Surg. 2006 Sep. 44(3):496-502. [Medline].
[Guideline] Zierler RE, Jordan WD, Lal BK, Mussa F, Leers S, Fulton J, et al. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. J Vasc Surg. 2018 Jul. 68 (1):256-284. [Medline]. [Full Text].
Cheong Jun Lee, MD Assistant Professor of Surgery, Division of Vascular Surgery, Medical College of Wisconsin
Cheong Jun Lee, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, Association for Academic Surgery, Michigan State Medical Society, Society for Vascular Surgery
Disclosure: Nothing to disclose.
Mark D Morasch, MD, RPVI Vascular Surgeon, Section Head of Vascular and Endovascular Services, Billings Clinic; John Marquardt Clinical Research Professor in Vascular Surgery, Division of Vascular Surgery, Northwestern University, The Feinberg School of Medicine
Mark D Morasch, MD, RPVI is a member of the following medical societies: Society for Vascular Surgery, Western Surgical Association, Southern Association for Vascular Surgery, American Venous Forum, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Western Vascular Society, Midwestern Vascular Surgical Society, American College of Surgeons, American Medical Association, American Heart Association, Central Surgical Association, Western Vascular Society, Southern Association for Vascular Surgery
Disclosure: Nothing to disclose.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
Femorofemoral (Femoral-Femoral) Bypass
Research & References of Femorofemoral (Femoral-Femoral) Bypass|A&C Accounting And Tax Services
Source
0 Comments