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Bontinis V, Bontinis A, Koudounas G, Kontes I, Giannopoulos A, Chorti A, Ktenidis K. Long-Term Outcomes of Anatomical and Extra-Anatomical Bypass for the Treatment of Unilateral Iliac Artery Lesions a Systematic Review Aggregated Data and Individual Participant Data Meta-Analysis. Ann Vasc Surg 2024; 104:296-306. [PMID: 38588957 DOI: 10.1016/j.avsg.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/27/2023] [Accepted: 02/15/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND We investigated the long-term safety and efficacy of anatomical and extra-anatomical bypass for the treatment of unilateral iliac artery disease. METHODS A systematic search on PubMed, Scopus and Web of science for articles published by June 2023 was performed. We implemented a 2-stage individual participant data meta-analysis and pooled survival probabilities using the multivariate methodology of DerSimonian and Laird. The primary endpoint was primary patency at 5 and 10 years of follow-up. RESULTS Ten studies encompassing 1,907 patients were included. The 5- and 10-year pooled patency rates for anatomical bypass were 83.27% (95% confidence interval (CI): 69.99-99.07) and 77.30% (95% CI: 60.32-99.04), respectively, with a mean primary patency time representing the duration individuals remained event-free for 10.08 years (95% CI: 8.05-10.97). The 5- and 10-year pooled primary patency estimates for extra-anatomical bypass were 77.02% (95% CI: 66.79-88.80) and 68.54% (95% CI: 53.32-88.09), respectively, with a mean primary patency time of 9.25 years, (95% CI: 7.21-9.68). Upon 2-stage individual participant data meta-analysis, anatomical bypass displayed a decreased risk for loss of primary patency compared to extra-anatomical bypass, hazard ratio 0.51 (95% CI: 0.30-0.85). The 5- and 10-year secondary patency estimates for anatomical bypass were 96.83% (95% CI: 90.28-100) and 96.13% (95% CI: 88.72-100), respectively. The 5- and 10-year secondary patency estimates for extra-anatomical bypass were 91.39% (95% CI: 84.32-99.04) and 85.05% (95% CI: 74.43-97.18), respectively, with non-statistically significant difference between the 2 groups. The 5- and 10-year survival for patients undergoing anatomical bypass were 67.99% (95% CI: 53.84-85.85) and 41.09% (95% CI: 25.36-66.57), respectively. The 5- and 10-year survival for extra-anatomical bypass were 70.67% (95% CI: 56.76-87.98) and 34.85% (95% CI: 19.76-61.44), respectively. The mean survival time was 6.92 years (95% CI: 5.56-7.89) for the anatomical and 6.78 years (95% CI: 5.31-7.63) for the extra-anatomical groups. The pooled overall 30-day mortality was 2.32% (95% CI: 1.12-3.87) with metaregression analysis displaying a negative association between the year of publication and mortality (β =-0.0065, P < 0.01). Further analysis displayed a 30-day mortality of 1.29% (95% CI: 0.56-2.26) versus 4.02% (95% CI: 1.78-7.03), (P = 0.02) for studies published after and before the year 2000. Non-statistically significant differences were identified between the 2 groups concerning long-term and 30-day mortality outcomes. CONCLUSIONS While we have demonstrated favorable long-term primary and secondary patency outcomes for both surgical techniques, anatomical bypass exhibited a reduced risk of primary patency loss potentially reflecting its inherent capacity to circumvent the anticipated disease progression in the distal aorta and the contralateral donor artery. The reduction in perioperative mortality observed in our review, coupled with the anachronistic demographic characteristics and inclusion criteria presented in the existing literature, underscores the imperative necessity for contemporary research.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Ioannis Kontes
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Argirios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Angeliki Chorti
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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Galyfos G, Charalampopoulos G, Chamzin A, Triantafillou A, Michalopoulou V, Intzes N, Kimpizi D, Zarmakoupis K, Sigala F, Filis K. Extra-anatomic bypass procedures for severe aortoiliac occlusive disease-A cohort study. Vascular 2024:17085381241236558. [PMID: 38407000 DOI: 10.1177/17085381241236558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Extra-anatomic bypass (ExAB) grafting has been questioned due its inferior durability compared to anatomic bypass for aortoiliac occlusive disease (AIOD). This study aims to present early and late outcomes of patients treated with ExAB as well as to evaluate potential prognostic factors. METHODS This is a retrospective cohort study presenting a series of patients treated with ExAB for AIOD. All patients were treated between 2005 and 2022 within the Vascular Surgery Unit of a University Surgery Clinic. Both early (30-day) and late outcomes were evaluated. Univariate and multivariate analyses were conducted for potential predictors. Kaplan-Meier curve was produced for long-term patency. RESULTS A total of 41 patients were treated (85.3% males; mean age: 76.3 ± 4.2 years). Indication for treatment included severe claudication or critical limb ischemia (Rutherford stages III-VI). The following procedures were recorded: Femorofemoral bypass (FFB; n = 21) and axillofemoral bypass (AxFB; n = 20). All procedures were conducted using synthetic grafts with external rings. Early outcomes included no death, no myocardial infarction, no major bleeding, no graft infection, and no major amputation. Regarding late outcomes, 14.6% patients were lost after the first month. For the rest of patients (n = 35), five-year primary patency was 88.6%, primary-assisted patency was 94.3%, and secondary patency was also 94.3%. Limb salvage was 100% within follow-up. Endarterectomy at the distal anastomosis was the only independent predictor associated with worse patency in the long-term (OR = 5.356; 95% CI (1.012-185.562); p = .041). CONCLUSIONS FFB and AxFB is a safe and durable strategy for treating patients with severe AIOD where no other option is feasible. Regarding predictors, only endarterectomy at the distal anastomosis site was associated with an increased risk for graft failure.
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Affiliation(s)
- George Galyfos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Charalampopoulos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Chamzin
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Triantafillou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Victoria Michalopoulou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Intzes
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Kimpizi
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Zarmakoupis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Frangiska Sigala
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Filis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Sunagawa M, Yokoyama Y, Banno H, Sugimoto M, Mizuno T, Yamaguchi J, Onoe S, Watanabe N, Kawakatsu S, Ebata T. Two-step arterial reconstruction technique for en bloc resection of a large retroperitoneal liposarcoma involving the common iliac artery. Surg Today 2023; 53:1320-1324. [PMID: 37079071 DOI: 10.1007/s00595-023-02684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare but challenging neoplasm, which is frequently associated with iliac vessel invasion. We describe how we used a two-step arterial reconstruction technique to perform en bloc resection of a large RPLS involving the iliac arteries in three patients. A temporal long in situ graft bypass was established using a prosthetic vascular graft during dissection of the tumor. This bypass provided an unobscured surgical field, while maintaining blood flow in the lower limb during the operation. After removal of the tumor and washing out the abdominal cavity, the new prosthetic vascular graft of a suitable length was placed. No graft-related complications, including vascular graft infection or graft occlusion, occurred during the follow-up period. This novel technique appears to provide a safe and effective way to remove large RPLSs involving the retroperitoneal major vessels.
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Affiliation(s)
- Masaki Sunagawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshi Banno
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Sugimoto
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shoji Kawakatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
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Gedney R, Wooster M. Pioneer re-entry into covered stent graft to recanalize occluded, jailed external iliac artery. J Vasc Surg Cases Innov Tech 2023; 9:101189. [PMID: 37799849 PMCID: PMC10547825 DOI: 10.1016/j.jvscit.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/28/2023] [Indexed: 10/07/2023] Open
Abstract
Aortoiliac occlusive disease in patients who are poor surgical candidates requires innovative strategies in endovascular surgery. We present a case of a 59-year-old gentleman with significant medical comorbidities and chronic limb-threatening ischemia secondary to a chronically occluded left-to-right cross-femoral bypass, as well as an occluded right iliac system owing to a jailed right external iliac artery from a prior common-to-internal iliac covered stent, originally done for buttock claudication. He was treated successfully from an endovascular approach with kissing stents in the right internal and external iliac arteries after gaining access to the old right common iliac stent via an ipsilateral access and use of a Pioneer intravascular ultrasound-guided re-entry catheter. Use of this strategy to treat complex aortoiliac occlusions in patients that are not suitable surgical candidates can be achieved effectively, even in the setting of existing prior ipsilateral stent grafts.
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Affiliation(s)
- Ryan Gedney
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Mathew Wooster
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
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Faruk M, Satria B, Alwi A, Cahyaningtyas C. A rare case of femoral artery saccular aneurysm caused by tuberculosis in a male patient: A case report and review of literature. Int J Surg Case Rep 2023; 106:108143. [PMID: 37062194 PMCID: PMC10139898 DOI: 10.1016/j.ijscr.2023.108143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is still a major global health issue. In over 75 % of all cases of mycotic aneurysm, TB spreads directly by eroding through the vascular wall. Aortic and innominate arteries are frequently the sites of tubercular aneurysms, primarily due to contiguous dissemination from pulmonary infection sites. We report a case of a saccular aneurysm at the distal common femoral artery associated with tuberculosis. CASE PRESENTATION A 34-year-old man had the chief complaint of a voluminous pulsatile mass in the left thigh. We found a bruit on auscultation examination at the site of the mass. A computed tomography (CT) angiography showed a saccular aneurysm at the distal common femoral artery and stenosis at the proximal femoral profunda artery. A chest CT scan was conducted, and the result showed a ground-glass appearance and multiple enlarged lymph nodes. CLINICAL DISCUSSION The patient was treated surgically by resection of the aneurysm and reconstruction with an inter-positional saphenous vein graft. Later, he was treated with a drug regimen for tuberculosis by pulmonologist. The patient was discharged with no post-operative complications. CONCLUSION Patients with femoral artery aneurysms are at high risk of rupture and death by exsanguination. It can be a severe complication of tuberculosis, especially in immunocompromised patients. Although this was a very rare case, all surgeons must be aware. A combination of medical and surgical intervention is imperative. Careful clinical care postoperatively is mandatory because of the risk of repetitive anastomotic aneurysms and recurrent aneurysms in another vessel.
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Affiliation(s)
- Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Bayu Satria
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ahmadi Alwi
- Department of Surgery, Tadjuddin Chalid Hospital, Makassar, Indonesia
| | - Cheria Cahyaningtyas
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Jung KS, Heo SH, Woo SY, Park YJ, Kim DI, Kim YW. Factors associated with long-term graft patency after lower extremity arterial bypasses. Ann Surg Treat Res 2021; 100:175-185. [PMID: 33748031 PMCID: PMC7943280 DOI: 10.4174/astr.2021.100.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was conducted to determine factors associated with long-term graft patency after lower extremity arterial bypass (LEAB). Methods Database of LEABs for patients with chronic arterial occlusive disease (CAOD) at a single institution was retrospectively reviewed. To determine the factors we compared demographic, clinical, and procedural variables between 2 patient groups; group I (graft patency < 2 years) and group II (graft patency ≥ 5 years after LEAB) using univariable and multivariable analyses. Results Among 957 LEABs, 259 limbs (group I, 125 limbs and group II, 134 limbs) in 213 patients were included for the analysis. On a univariable analysis, younger age (69 years vs. 66 years, P = 0.024), hypertension (60.8% vs. 74.6%, P = 0.017), claudication (51.2% vs. 70.9%, P = 0.001), absence of prior intervention (50.4% vs. 73.9%, P < 0.001), common femoral artery based bypass (57.6% vs. 70.1%, P = 0.035), above-the knee bypass (36.8% vs. 64.2%, P < 0.001), postoperative graft salvage procedure (3.2% vs. 14.8%, P = 0.001), and statin use (75.2% vs. 88.8, P = 0.004) were associated with long-term patency. On a multivariate analysis hypertension (odds ratio [OR], 1.91; P = 0.038), claudication (OR, 2.08; P = 0.032), no prior intervention (OR, 2.48; P = 0.001), vein graft (OR, 4.36; P = 0.001), above-the knee bypass (OR, 4.68; P < 0.001), and graft salvage procedures (OR, 7.70; P < 0.001) were identified as independent factors. Conclusion These factors can be considered in decision making before treatment of patients with CAOD.
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Affiliation(s)
- Ki-Sang Jung
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Miyama N, Komai H, Nakamura T, Iwahashi M, Mukobara N, Yoshida M, Fujimura H, Sugimoto T, Asada H, Tanimura N, Azami T, Kawata M, Tsuji Y, Wakita N, Ogino H, Shindo S, Hatada A, Oka T. Long-Term Results of Crossover Bypass for Iliac Atherosclerotic Lesions in the Era of Endovascular Treatment: The Re-ACTION Study ( Retrospective Assessment of Crossover Bypass as a Treatment for Iliac Lesi ONs). Ann Vasc Dis 2018; 11:217-222. [PMID: 30116414 PMCID: PMC6094041 DOI: 10.3400/avd.oa.18-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to elucidate the long-term results of crossover bypass (CB) for iliac atherosclerotic lesions in the era of endovascular treatment (EVT). Methods: A retrospective multicenter cohort study was performed. CB was performed in 242 patients between 2003 and 2014 by vascular surgeons at multiple medical centers in Japan. Results: Perioperative mortality was 1.7%. Primary patency rates were 86% at 5 years and 82% at 8 years. Univariate analysis showed that critical limb ischemia (Rutherford class 4–6), vein graft, and superficial femoral artery occlusion were significantly associated with low primary patency. In multivariate analysis, only critical limb ischemia influenced primary patency. The secondary patency rate was 87% at both 5 and 8 years. The limb salvage rate was 98% at both 5 and 8 years. The overall survival rates were 71% at 5 years and 49% at 8 years. Conclusion: The long-term results of CB were good in our study, compared with previous reports. Our results suggest that CB remains an option for the arterial reconstruction in unilateral iliac occlusive disease after EVT failed.
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Affiliation(s)
- Noriyuki Miyama
- Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Japan.,Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Takashi Nakamura
- Department of Vascular Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Masahiro Iwahashi
- Department of Cardiovascular Surgery, National Hospital Organization Wakayama Hospital, Wakayama, Japan.,Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Nobuhiko Mukobara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Masato Yoshida
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takaki Sugimoto
- Department of Cardiovascular Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Hidenori Asada
- Department of Vascular Surgery, Kyoto Medical Center, Kyoto, Japan
| | - Nobuhiro Tanimura
- Department of Vascular Surgery, Soryukai Inoue Hospital, Suita, Japan.,Department of Cardiovascular Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - Takashi Azami
- Department of Cardiovascular Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Masatoshi Kawata
- Department of Cardiovascular Surgery, Saiseikai Suita Hospital, Suita, Japan
| | - Yoshihiko Tsuji
- Department of Surgery, Shinsuma General Hospital, Kobe, Japan
| | - Noboru Wakita
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Kobe, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shunya Shindo
- Department of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Atsutoshi Hatada
- Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Takanori Oka
- Department of Cardiovascular Surgery, Takatsuki General Hospital, Takatsuki, Japan
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Venous Conduits Have Superior Patency Compared with Prosthetic Grafts for Femorofemoral Bypass. Ann Vasc Surg 2018; 52:126-137. [PMID: 29783030 DOI: 10.1016/j.avsg.2018.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of the study was to compare the outcomes of externally supported polytetrafluoroethylene (PTFE) grafts and femoral vein as conduits for femorofemoral crossover grafts. METHODS This is a retrospective review of consecutive femorofemoral crossover grafts at our institution between January 2005 and March 2016. Patient demographics, indications, complication rates, patency rates, and survival rates were compared between femorofemoral grafts created with either PTFE or femoral vein conduits, autogenous or cryopreserved. RESULTS One hundred nineteen femorofemoral crossover bypasses (89 PTFE, 30 vein [18 autogenous and 12 cryopreserved femoral veins]) were performed. Most patients underwent isolated femorofemoral bypass alone (76% isolated femorofemoral bypass versus 24% axillobifemoral bypass). A greater proportion of patients who received vein grafts were female (PTFE 37% vs. vein 60%, P = 0.028) and had prior bypasses (PTFE 33% vs. vein 73%, P < 0.001). PTFE bypasses were performed primarily for chronic limb ischemia (61.8%), while most venous bypasses were for infections (80%, P < 0.001). Femoral vein conduits were used in cases of infected aortic or extra-anatomical grafts (N = 20) or groin infection (N = 5). The 30-day complication rate was 38.7% and was not different between groups (36% for PTFE, 44.4% for autologous vein grafts and 50% for cryovein, P = 0.33) with wound complications being most frequent (18% PTFE, 27.8% autologous vein, 16.7% cryovein, P = 0.25). Patients receiving vein grafts were more likely to receive blood transfusion (34.8% PTFE vs. 70% vein, P = 0.001). Overall, median follow-up was 9.8 months (range 0-107). Primary patency rates at 1, 2, and 3 years were 83.7 %, 73.7% and 69.8%, respectively, for PTFE bypasses, and 100% for all time points for venous grafts, respectively (log rank, P = 0.03). Primary-assisted and secondary patency rates were not significantly different between the 2 groups (log rank, P = 0.16). Survival rates at 1, 2, and 3 years were 82%, 76.4% and 69.7%, respectively, for patients with PTFE grafts versus 76.7%, 73.3%, and 55%, respectively, for patients with vein grafts, respectively (log rank, P = 0.17). CONCLUSIONS While the indications for procedure differed in this series, femoral veins in femorofemoral bypasses have overall superior primary patency and similar complication rates compared with PTFE grafts. Based on this series, femoral vein, either autologous or cryopreserved, appears to be a suitable conduit for femorofemoral bypasses, and in some cases, it may be the preferred conduit.
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Akingboye AA, Patel B, Cross FW. Femorofemoral Crossover Bypass Graft Has Excellent Patency When Performed with EVAR for AAA with UIOD. South Med J 2018; 111:56-63. [PMID: 29298371 DOI: 10.14423/smj.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare the durability of the crossover femorofemoral bypass graft (CFFBG) in combination with aorto-uni-iliac stent graft (AUIS) for abdominal aortic aneurysm with the durability of CFFBG used in the treatment of unilateral iliac occlusive disease (UIOD). METHODS We analyzed the clinical records of 69 patients who underwent CFFBG from 1992 until 2010. Group I consisted of 34 patients who received CFFBGs in combination with AUIS. Group II consisted of 35 patients treated with CFFBG for UIOD. The mean period of follow up was 2.7 years. Outcomes analyzed included primary graft patency, secondary graft patency, and postoperative morbidity and mortality. RESULTS There was one death in each group. Wound infection complicated 11.4% of CFFBGs performed as a sole procedure for UIOD and 5.8% of cases in combination with AUIS (P = 0.673). Primary graft patency was 96.5% and 96.5% at 2 and 5 years in group I, compared with 76.6% and 53.7% in group II (P = 0.046, 0.009). Secondary graft patency at 5 years was 100% and 92.9% for groups I and II, respectively. No variables independently influenced primary graft patency. Patients in group I experienced complications that could be linked to the bypass graft in 20.5% of cases, after long-term follow-up. CONCLUSIONS The CFFBG possesses superior long-term durability and patency when implemented in combination with aorto-uni-iliac stent grafts and does not seem to compromise the endpoint success of endovascular treatment.
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Affiliation(s)
- Akinfemi A Akingboye
- From the Royal London Hospital and Barts Cancer Institute, Queen Mary University of London, London, and Department of General Surgery, Colchester Hospital University Foundation Trust, Essex, United Kingdom
| | - Bijendra Patel
- From the Royal London Hospital and Barts Cancer Institute, Queen Mary University of London, London, and Department of General Surgery, Colchester Hospital University Foundation Trust, Essex, United Kingdom
| | - Frank W Cross
- From the Royal London Hospital and Barts Cancer Institute, Queen Mary University of London, London, and Department of General Surgery, Colchester Hospital University Foundation Trust, Essex, United Kingdom
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Park KM, Park YJ, Kim YW, Hyun D, Park KB, Do YS, Kim DI. Long Term Outcomes of Femorofemoral Crossover Bypass Grafts. Vasc Specialist Int 2017; 33:55-58. [PMID: 28690996 PMCID: PMC5493187 DOI: 10.5758/vsi.2017.33.2.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/05/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
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Affiliation(s)
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Obinwa O, Canning C, O'Donohoe M. Bilateral prevascular herniae - A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass. Int J Surg Case Rep 2015; 11:5-7. [PMID: 25890122 PMCID: PMC4446676 DOI: 10.1016/j.ijscr.2015.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
A case of a 78-year-old female with bilateral prevascular groin herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach for dealing with this rare complication.
A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.
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Affiliation(s)
- Obinna Obinwa
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
| | - Caitriona Canning
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
| | - Martin O'Donohoe
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
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Ma T, Ma J. Femorofemoral Bypass to the Deep Femoral Artery for Limb Salvage after Prior Failed Percutaneous Endovascular Intervention. Ann Vasc Surg 2014; 28:1463-8. [DOI: 10.1016/j.avsg.2014.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/28/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
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Kim YS, Yun WS, Park K. Long-term outcome of crossover femoro-femoro-popliteal bypass using side-to-side anastomosis in ilio-femoral occlusive disease. Ann Surg Treat Res 2014; 86:91-4. [PMID: 24761414 PMCID: PMC3994596 DOI: 10.4174/astr.2014.86.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/13/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose During crossover femoro-femoro-popliteal sequential bypass (CFFPB) surgery in ilio-femoral occlusive disease, proximal anastomosis of the femoro-popliteal bypass is usually performed distal to the distal anastomosis of the crossover femoro-femoral bypass. If not, it is done with a piggyback configuration. Another method is a side-to-side anastomosis. Its benefit is that this is the only anastomosis made. And it is less bulky compared with the piggyback configuration. This study was aimed to investigate the long-term outcome of CFFPB using side-to-side anastomosis. Methods From Sep 2006 to Aug 2012, 21 patients who underwent CFFPB using side-to-side anastomosis were enrolled. Externally supported polytetrafluoroethylene graft was used as a conduit in all patients. Patient demographic data and procedure details were investigated. Primary graft patency was calculated using the Kaplan-Meier method. Results The mean age of patients was 79 years (range, 62-81 years) and males were 17 (81%). Fifteen patients (71%) had critical limb ischemia. Inflow arteries comprised of 16 common femoral artery (CFA), 4 superficial femoral artery (SFA), and 1 deep femoral artery (DFA). Side-to-side anastomosis was performed on the CFA in 11, SFA in 2, and DFA in 8 patients. During the mean follow-up period of 21 months (1-60 months), 8 patients died. The 1-, 3-, and 5-year primary patency rates were 76%, 63%, and 63%. Conclusion Long-term patency of CFFPB using side-to-side anastomosis was acceptable. It can be one of the treatment options for patients with ilio-femoral occlusive disease.
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Affiliation(s)
- Yoon-Sub Kim
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Woo-Sung Yun
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kihyuk Park
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Dosluoglu HH. Commentary: Endovascular Therapy Should Be the First Line of Treatment in Patients With Severe (TASC II C or D) Aortoiliac Occlusive Disease. J Endovasc Ther 2013; 20:74-9. [DOI: 10.1583/12-4014c.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Affiliation(s)
- David Paul Slovut
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
| | - Evan C. Lipsitz
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
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Abstract
Critical limb ischemia represents the most severe form of peripheral arterial disease and carries with it severe morbidity and mortality risks. Because of comorbidity risks, early diagnosis and aggressive medical management make up an important part of the treatment paradigm for these individuals. However, in addition to managing these comorbid conditions, the physician caring for these individuals must be able to provide revascularization options that will improve arterial flow to the threatened extremity and assure healing of complicated wounds. Both open surgical and endovascular therapies have proven beneficial in restoring flow to severely ischemic limbs in these patients. Additionally, combinations of the above therapeutic methods have offered more available options for these patients. This article reviews care of patients with critical limb ischemia with critical assessment of options for medical and revascularization options.
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Affiliation(s)
- Dan Clair
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine,Cleveland, OH 44195, USA.
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Rinckenbach S, Guelle N, Lillaz J, Al Sayed M, Ritucci V, Camelot G. Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results. Ann Vasc Surg 2011; 26:359-64. [PMID: 22050878 DOI: 10.1016/j.avsg.2011.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/18/2011] [Accepted: 04/03/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess our current practice concerning the indications and the immediate and midterm results of femorofemoral bypass. METHODS We retrospectively included all patients, from 1997 to 2008, operated on for aortoiliac occlusive disease using an extra-anatomical bypass from a donor iliac artery or a femoral artery to the contralateral femoral artery (common or profunda artery). Demographic data, initial clinical status, characteristics of the interventions, and short- and midterm results were collected. Elective surgery was distinguished from urgent surgery (critical limb ischemia, acute ischemia, vascular infection). RESULTS One hundred twenty-four femorofemoral bypasses were performed (103 male), mean age 68 (±12) years. Indications were critical limb ischemia (47.1%), intermittent claudication (38.8%), acute ischemia (12.1%), and vascular infections (1.7%). Perioperative outcomes were 5.6% mortality (elective surgery 0.0%, urgent surgery 9.7%, P = 0.02) and 27.4% morbidity without any secondary graft infections (elective surgery 22.5%, urgent surgery 31.9%, P = 0.17). Mean follow-up period was 3 years, and overall survival was 69.4% (elective surgery 88.7%, urgent surgery 56.7%, P = 0.08). At 3 years, primary patency was 81.8% and secondary patency was 89.3% (elective surgery 96.4%, urgent surgery 84.2%, P = 0.68). No significant risk factors for immediate and secondary thromboses were found. CONCLUSION In our current practice, femorofemoral bypasses are applied mainly for urgent procedures when avoiding a direct aortic approach is mandatory, with good midterm results. Although indications are limited for good-fit patients, femorofemoral bypass has confirmed safety (no perioperative deaths, no infections) and high durability (good secondary patency).
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Affiliation(s)
- Simon Rinckenbach
- Vascular Surgery Unit, University Hospital of Besancon, Besancon, France.
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18
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[Factors influencing early results of femoro-femoral crossover bypass]. SRP ARK CELOK LEK 2011; 139:143-8. [PMID: 21626759 DOI: 10.2298/sarh1104143d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Femoro-femoral crossover bypass is an extraanatomic reconstruction used for revascularization of lower limb with contralatateral femoral artery as an inflow vessel, and the graft placed in the suprapubic region. We perform this procedure when anatomic reconstruction is not possible or is contraindicated. OBJECTIVE To analyze the influence of different risk factors on early patency of femoro-femoral crossover bypass. METHODS This retrospective study analyzed the results of 88 femoro-femoral bypass grafting during an 11-year period. There were 66 (75%) males and 22 (25%) females of average age 64.93 years (42-79 years). In 76 patients the operations were performed due to critical limb ischemia. Revascularization was urgent in 12 patients, while 76 patients were elective. Dacron prosthesis was used in 81 patients, while PTFE was used in 7 patients. Statistical analysis was made by logistic regression. RESULTS During hospitalisation the graft remained patent in 82 patients, and graft thrombosis occurred in 6 patients. Limb salvage rate was 90.91%. Early morbidity rate (within the first postoperative month) was 13.64%, while early mortality rate was 4.55%. Using logistic regression we established that early graft patency was statistically more significant in males (p < 0.05). Age (p = 0.07) and hypertension (p = 0.08) appeared to be predicting influence of the graft patency on the border of the accepted statistical significance level. CONCLUSION Femoro-femoral crossover bypass is a good alternative for revascularization in high risk patients for standard anatomic reconstructions due to comorbid conditions or local problems.
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Capoccia L, Riambau V, da Rocha M. Is Femorofemoral Crossover Bypass an Option in Claudication? Ann Vasc Surg 2010; 24:828-32. [DOI: 10.1016/j.avsg.2010.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 03/03/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
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Beard JD. Which is the best revascularization for critical limb ischemia: Endovascular or open surgery? J Vasc Surg 2008; 48:11S-16S. [DOI: 10.1016/j.jvs.2008.08.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 08/06/2008] [Accepted: 08/12/2008] [Indexed: 11/25/2022]
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Heredero AF, Stefanov S, del Moral LR, Leblic I, Nistal MG, Mendieta C, de Cubas LR. Long-term Results of Femoro-Femoral Crossover Bypass After Endovascular Aortouniiliac Repair of Abdominal Aortic and Aortoiliac Aneurysms. Vasc Endovascular Surg 2008; 42:420-6. [DOI: 10.1177/1538574408318008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortouniiliac stent grafts allow the endovascular treatment of complex anatomy aortoiliac aneurysms. The main drawback is the need for femoro-femoral crossover bypass, with its complications and its patency limitations. However, some authors have shown good results of femoro-femoral crossover bypass in aneurysmal disease. In this article, initial and long-term results of our experience in femoro-femoral crossover bypass revascularization after endovascular aortouniiliac stent grafts repair of aortoiliac aneurysms is reported. Prospective collection, intention-to-treat, and retrospective analysis maintained database. Femoro-femoral crossover bypass patency assessment of all patients treated between January 1999 and September 2002, compared patients with or without associated occlusive arterial disease. Urgent indications were excluded. In total of 52 patients, with a mean age 72.6 years, 30.8% of patients were identified with associated occlusive arterial disease. Initial systemic and local, access site, complications were 7.7% and 7.7%, respectively, no early thrombosis or death is reported. Primary patency was 90.9% at 54 months, 66 months assisted primary and secondary patency were 97.7% and 100%, respectively. The 48-month survival rate was 84.2%. No significant differences between patients with or without associated occlusive arterial disease were found. Femoro-femoral crossover bypass after aortouniiliac stent grafts treatment of aortoiliac aneurysms shows excellent initial and long-term patency and low complication rate.
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Affiliation(s)
- Alvaro F. Heredero
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain,
| | - Stefan Stefanov
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - L. Riera del Moral
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Israel Leblic
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Marta G. Nistal
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Covadonga Mendieta
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - L. Riera de Cubas
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz, Madrid, Spain
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22
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Thuijls G, van Laake L, Lemson M, Kitslaar P. Usefulness and Applicability of Femorofemoral Crossover Bypass Grafting. Ann Vasc Surg 2008; 22:663-7. [DOI: 10.1016/j.avsg.2008.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 02/25/2008] [Accepted: 04/28/2008] [Indexed: 11/26/2022]
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Ricco JB, Probst H. Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease. J Vasc Surg 2008; 47:45-53; discussion 53-4. [PMID: 17997269 DOI: 10.1016/j.jvs.2007.08.050] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/21/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
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Fatourou EM, Paraskevas KI, Seifalian AM, Hamilton G, Mikhailidis DP. The role of established and emerging risk factors in peripheral vascular graft occlusion. Expert Opin Pharmacother 2007; 8:901-11. [PMID: 17472536 DOI: 10.1517/14656566.8.7.901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several studies have evaluated the association between established as well as emerging vascular risk factors with peripheral graft occlusion. There is evidence for a link between the risk for graft occlusion and total serum cholesterol, low-density lipoprotein cholesterol and triglyceride levels. The overall effect of smoking shows a 2.35-fold increase in risk of graft failure. Studies involving diabetic patients undergoing peripheral bypass may have failed to detect higher occlusion rates, possibly due to increased morbidity and mortality as well as higher amputation rates even if the graft is patent. Both antiplatelet agents and anticoagulation seem to be effective in the prevention of graft occlusion. Unconvincing data have been published with regards to the effect of hypertension on graft patency. Emerging factors such as fibrinogen, lipoprotein (a), C-reactive protein and homocysteine levels should also be considered when assessing the risk of graft occlusion. More research is needed to prevent graft occlusion due to the obvious clinical relevance, quality of life and cost issues.
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Affiliation(s)
- E M Fatourou
- Department of Clinical Biochemistry, Royal Free Hospital and Royal Free University College Medical School, London, UK
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25
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Eiberg JP, Røder O, Stahl-Madsen M, Eldrup N, Qvarfordt P, Laursen A, Greve M, Flörenes T, Nielsen OM, Seidelin C, Vestergaard-Andersen T, Schroeder TV. Fluoropolymer-coated Dacron Versus PTFE Grafts for Femorofemoral Crossover Bypass: Randomised Trial. Eur J Vasc Endovasc Surg 2006; 32:431-8. [PMID: 16807001 DOI: 10.1016/j.ejvs.2006.04.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/06/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery. DESIGN A randomised multicentre clinical trial comparing two vascular grafts with participation of 10 departments of vascular surgery in Denmark, Sweden and Norway. PATIENTS AND METHODS 198 patients were randomised to PTFE (n=107) or fluoropolymer-coated Dacron grafts (n=91), 63% underwent surgery for claudication, 27% for ischaemic rest pain and 10% for tissue loss. The median follow-up time was 24 months (IQR 19-26 months). RESULTS The primary patency rate of the two grafts was similar (log rank test: p=0.35). The primary patency rates (95% CI) for coated Dacron and PTFE grafts were 92% (86-98) and 94% (89-99) at 12 months and 87% (74-95) and 93% (87-99) at 24 months, respectively. CONCLUSION In patients with unilateral iliac artery disease not amenable to angioplasty, the femoral-femoral bypass is durable and effective. No difference in patency was found between the two graft materials (fluoropolymer coated Dacron and PTFE).
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Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
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Stone PA, Armstrong PA, Bandyk DF, Keeling WB, Flaherty SK, Shames ML, Johnson BL, Back MR. Duplex ultrasound criteria for femorofemoral bypass revision. J Vasc Surg 2006; 44:496-502. [PMID: 16950423 DOI: 10.1016/j.jvs.2006.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 06/03/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE This study was conducted to evaluate the impact of duplex ultrasound surveillance on the patency of femorofemoral bypasses performed for symptomatic peripheral arterial occlusive disease (PAOD). METHODS A retrospective review was conducted of 108 patients (78 men, 30 women) with a mean age of 62 +/- 10 years who underwent femorofemoral prosthetic (n = 100) or vein (n = 8) bypass grafting for symptomatic PAOD (claudication, 38%; rest pain, 41%; tissue loss, 11%; infection, 10%) during a 10-year period. Prior or concomitant inflow iliac artery stenting was performed in 26 patients (24%), and a redo femorofemoral bypass was performed in 19 patients (18%). Duplex ultrasound surveillance of the reconstruction was performed at 6-month intervals to assess patency, graft (midgraft peak systolic flow velocity) hemodynamics, and identify inflow or outflow stenotic lesions. Repair was recommended for a stenosis with a peak systolic velocity (PSV) >300 cm/s and a PSV ratio >3.5. Life-table analysis was used to estimate primary, assisted-primary, and secondary graft patency. RESULTS During a mean 40-month follow-up (range, 2 to 120 months), 31 bypasses (29%) were revised: 19 duplex-detected stenosis involving the inflow iliac artery (n = 15) or anastomotic stenosis (n = 4), or both, 11 for graft thrombosis, and 1 for graft infection. Abnormal inflow iliac (PSV >300 cm/s) hemodynamics or a mid-graft PSV <60 cm/s was measured in eight of 11 grafts before thrombosis. Mean time to revision was 30 +/- 17 months. The primary graft patency at 1, 3, and 5 years was 86%, 78%, and 62%, respectively. Correction of duplex-detected stenosis resulted in assisted-primary patency of 95% at 1 year and 88% at 3 and 5 years (P < .0001, log-rank). Secondary graft patency was 98% at 1 year and 93% at 3 and 5 years. CONCLUSIONS Vascular laboratory surveillance after femorofemoral bypass that included duplex ultrasound imaging of the inflow iliac artery and graft accurately identified failing grafts. A duplex-detected identified stenosis with a PSV >300 cm/s correlated with failure, and repair of identified lesions was associated with excellent 5-year patency.
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Affiliation(s)
- Patrick A Stone
- Division of Vascular & Endovascular Surgery, University of South Florida College of Medicine, Tampa, 33606, USA
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