Extra-anatomic femoro-femoral crossover bypass (FF) vs. unilateral orthotopic ilio-femoral bypass (IF): an attempt to compare results based on data matching.
Some surgeons feel that femoro-femoral suprapubic crossover bypass (FF) is the treatment of choice in unilateral artery disease, whereas others reserve this procedure for the rare high risk patient. Results and their evaluation seem to differ depending upon the indications and the patients elected for comparison. We analysed 57 consecutive patients, who received a FF-PTFE graft between 1977 and 1989 (age 48-95 years; male/female 47/10; preoperative clinical status [Fontaine Classification] St. II: 19%, St. III: 58%, St. IV: 23%; diabetics: 14; smokers: 40). The estimated cumulative primary and secondary patency according to the Kaplan-Meier method were 52 +/- 10% (three grafts at risk) and 63 +/- 10% (six grafts at risk), respectively at 5 years. There was no statistical difference in the secondary patency comparing patients with a good and bad run-off (Breslow, Mantel-Cox). The cumulative 5-year survival was 35 +/- 7% (nine patients at risk). The results were compared with those obtained in a group of 150 patients, in whom an unilateral ilio-femoral (IF) retroperitoneal orthotopic graft had been implanted for the same indication and within the same period. Comparing the primary patency of FF and IF patients (55 +/- 6%; 24 grafts at risk) no significant difference could be seen at 5 years. But there was a significant difference in the 5-year survival rates, being in favour of the IF-group (43 +/- 5%; 43 patients at risk) suggesting that both groups were not comparable.(ABSTRACT TRUNCATED AT 250 WORDS)
Kretschmer
G
G
Department of Surgery 1, University of Vienna, Medical School, Austria.
Niederle
B
B
Schemper
M
M
Polterauer
P
P
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D016019:Survival Analysis; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology