title: Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair?
abstract: OBJECTIVE
  The need for cross-femoral bypass grafting (CFBG) is considered by some to be a major disadvantage of endovascular aneurysm repair (EVAR) with the aortomonoiliac technique. To determine the durability of CFBG in this setting, we examined data from 148 consecutive high-risk patients in a clinical trial of EVAR with a custom-made aortomonoiliac endovascular stent graft.
  
  
  METHODS
  All data were collected prospectively. After hospital discharge, patients were evaluated at 1, 3, and 6 months and annually thereafter. All CFBG was constructed of expandable polytetrafluoroethylene.
  
  
  RESULTS
  During follow-up averaging 23.6 +/- 16.2 months, nine CFBG complications developed in 8 patients (5.4%), including disruption (n = 2), infection (n = 3), thrombosis (n = 2), and pseudoaneurysm (n = 3). Four patients with CFBG complications died, of consequences of infection (n = 2), intracranial hemorrhage during attempted CFBG thrombolysis (n = 1), and intracranial hemorrhage during anticoagulation (n = 1). There were no amputations. At life table analysis, freedom from CFBG complication was 96.3% +/- 1.6% at 12 months, 94.1% +/- 2.2% at 24, 36, and 48 months, and 86.2% +/- 7.8% at 60 months. Overall survival for this high-risk patient group was 83.4% +/- 3.1% at 12 months, 70.4% +/- 4.1% at 24 months, 56.5% +/- 5.3% at 36 months, and 44.8% +/- 6.4% at 48 months.
  
  
  CONCLUSIONS
  CFBG is durable, with a low rate of complications in patients undergoing aortomonoiliac EVAR. Need for CFBG should not discourage use of aortomonoiliac devices in patients with anatomy unfavorable for other EVAR approaches.
authors.affiliation: Department of Surgery, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Lâl P K
authors.initials: LP
authors.lastname: Yilmaz
authors.forename: Cherrie Z
authors.initials: CZ
authors.lastname: Abraham
authors.forename: Linda M
authors.initials: LM
authors.lastname: Reilly
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
authors.forename: Timothy A M
authors.initials: TA
authors.lastname: Chuter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents