Durability of femorofemoral bypass grafting after aortouniiliac endovascular aneurysm repair.
BACKGROUND
Endovascular aneurysm repair (EVAR) with aortouniiliac prostheses extends the morphologic range of aneurysms that can be treated and is potentially a more rapid and simple operation than bifurcated endovascular repair. It may, however, be limited by durability of the femorofemoral extra-anatomic bypass graft required to revascularize the contralateral lower limb. Previous studies of femorofemoral bypass grafts were performed almost exclusively in patients with occlusive disease. An 8-year single center experience with use of the femorofemoral bypass graft in aneurysmal disease is reported.


METHODS
All patients undergoing EVAR with an aortouniiliac endovascular stent graft over eight years (1994-2002) at a single institution were included in a retrospective study. Patient data were collected from a prospectively maintained local endovascular database. All patients gave informed consent and were part of an endovascular program approved by the local ethics committee.


RESULTS
Over the 8 years, 231 patients underwent EVAR with an aortouniiliac endovascular stent-graft. Median follow-up was 22 months. Localized wound complications were observed in 25 patients (11%). Cumulative 3-year patency rate for the femorofemoral bypass graft was 91%. At the end of 5 years 83% of grafts remained patent.


CONCLUSIONS
The femorofemoral bypass graft used during EVAR with aortouniliac stent grafts offers encouraging medium and long-term patency. When graft occlusion occurs, it is usually directly attributable to inadequate inflow from the endovascular stent graft itself or to endoluminal damage of the external iliac artery. Awareness and early detection of stent-graft distortion or complications in the external iliac artery may result in improved patency rates.
Hinchliffe
Robert J
RJ
Department of Vascular and Endovascular Surgery, University Hospital, England. robhinchliffe@hotmail.com
Alric
Pierre
P
Wenham
Peter W
PW
Hopkinson
Brian R
BR
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects*; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*