title: [Reoperation on the femoral arterial bifurcation: technical notes and surgical strategy].
abstract: Femoral bifurcation reoperation is a stern test for skilfull surgeons, owing to the presence of thick scar tissue from the previous operations, especially when prosthetic grafts are used. In cases of aorto-femoral graft thrombosis, if thrombectomy of the entire graft is possible, one could isolate the anastomotic tract with all the afferent vessels and construct a new anastomosis downstream in tissue which allows a better run-off. Often in our experience we executed a by-pass, with a vein or short tract of new graft, from the previous prosthetic branch to a distal part of the deep femoral artery. In this way the reoperation is faster and safer, limiting dangerous dissection times. In infected inguinal pseudo-aneurysms we prefer an axillo-femoral by-pass, with isolation of the deep femoral artery by lateral incision, outside the infected field. In the non-infected ones, the reconstruction involves the use of a new small-sized graft between the previous structures. In cases of femoro-femoral occlusion we think it is better, first of all, to evaluate the possibility of an orthotopic graft from the aorta or iliac artery.
authors.affiliation: Unità Operativa Semplice di Chirurgia Vascolare, Dipartimento per le Applicazioni in Chirurgia delle Tecnologie Innovative, Università degli Studi di Bari.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardia
authors.forename: Valentina
authors.initials: V
authors.lastname: Cianci
authors.forename: Domenico
authors.initials: D
authors.lastname: Merlicco
mesh_terms: D017541:Aneurysm, False / Q000601:surgery*; D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D013927:Thrombosis / Q000601:surgery*