title: Femoro-femoral arterial bypass is an effective and durable treatment for symptomatic unilateral iliac artery occlusion.
abstract: OBJECTIVE
  This study was designed to determine the effectiveness of femoro-femoral arterial bypass (FFB) operation at hospital discharge and 1 year after operation, and to determine the role of long saphenous vein (LSV) as a conduit.
  
  
  RESULTS
  A retrospective review was undertaken of 161 consecutive patients (median age, 66 years; range, 44-97 years) who had femoro-femoral grafts during the 12 years from July 1987 to March 1999. The indication for operation was claudication in 66 patients and critical ischaemia in 95. A synthetic graft was used in 123 patients and LSV in 38. Six patients with LSV had a previously infected synthetic graft and 2 a previously occluded synthetic graft. In-hospital operative mortality was 13 (8.1%). One year postoperatively, known mortality was 29, fifteen patients were lost to follow-up putting 1-year mortality at 18.0-27.3%. Eight of these had LSV as the conduit. At discharge from hospital, the median improvement in the ankle brachial pressure index was 0.3 (range, 0-1.0) overall, and 0.32 for patients with LSV (range 0-1.0). Among the 117 known survivors at 1 year, secondary graft patency was 107 confirmed by Doppler or duplex (91.5%) overall, and 25 (89.3%) for LSV; 100 (85.5%) maintained symptomatic improvement, 11 (9.4%) were experiencing no benefit and 6 (5.1%) were worse, of whom 2 had undergone amputation. In patients in whom LSV was used, 22 (78.8%) remained symptomatically improved, 3 (10.7%) experienced no benefit, 3 deteriorated and one had an amputation.
  
  
  CONCLUSIONS
  One year following FFB, at least 18.0% of patients were dead. Among possible survivors to 1-year, graft patency was at least 78.8% and at least 75.8% remained clinically improved. FFB is effective in the treatment of unilateral iliac artery occlusion. LSV is as effective as a synthetic conduit.
authors.affiliation: Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK. m.pai@ucl.ac.uk
authors.forename: Mahesh
authors.initials: M
authors.lastname: Pai
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
authors.forename: Linda
authors.initials: L
authors.lastname: Hands
authors.forename: Jack
authors.initials: J
authors.lastname: Collin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery; D007383:Intermittent Claudication / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency