The crossover femoropopliteal bypass: a useful option for unilaterial iliofemoral occlusive disease.

Abstract

To study the outcome of treating critical limb ischaemia due to concurrent, unilateral iliac and femoral arterial occlusive disease by the placement of a crossover femoropopliteal bypass graft. Retrospective study of 10 patients unfit for aortic reconstruction whose disease was not amenable to endovascular therapy who were treated with this graft. Seven grafts originated from the common femoral artery, two from aortobifemoral graft limbs and one from the common iliac artery. There was not direct revascularisation of the profunda femoris artery. The distal anastomosis was to the above-knee popliteal artery in nine cases and to the below-knee popliteal artery in one. Follow-up after discharge from hospital consisted of regular ankle-brachial index measurement and Duplex ultrasound scan assessment to record graft patency and limb salvage. The median duration of secondary patency was 52.5 months (range 14-84). During follow-up, there were four occlusive events. One graft had its patency restored, but in the other three patients, graft occlusion was associated with limb loss (at 18, 51 and 83 months respectively). In one of this latter group, surveillance had identified a failing graft and a jump graft prolonged patency for a further 34 months. This experience demonstrates that the crossover femoropopliteal bypass achieves satisfactory limb salvage in patients with extensive iliofemoral occlusive disease who are not suitable for major aortic reconstruction.