Iliac endarterectomy with crossover ileofemoral bypass grafting for bilateral iliac artery stenosis.
The high-risk patient with claudication or impending limb loss secondary to iliac artery occlusive disease presents a difficult management problem. The morbidity and operative mortality rates of an aortoiliac or aortofemoral bypass procedure can be significant in the elderly or high-risk patient with multiple medical problems. An alternative to the axillofemoral bypass graft and other procedures that have been used in this clinical setting is presented. The combination of endarterectomy of the donor iliac vessel and retrorectus crossover bypass graft has been used in five patients, with good results at 6-month to 2-year follow-up. There have been no operative deaths and a retroperitoneal hematoma has been the only complication. One patient required balloon catheter dilatation of a stenotic vessel distal to the bypass graft for relief of recurrent claudication symptoms. This procedure appears to be a safe and effective therapeutic option in the patient considered an unsuitable candidate for aortofemoral bypass grafting because of advanced age or associated medical problems.
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004691:Endarterectomy; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male