Critical appraisal of femorofemoral crossover grafts.
BACKGROUND
The aim of this study was to determine how often femorofemoral crossover grafting for critical ischaemia or intermittent claudication gives an ideal result. An ideal result is an uncomplicated operation with primary wound healing, relief of ischaemic symptoms without recurrence and no need for further intervention.


METHODS
All patients undergoing primary femorofemoral crossover grafting between January 1988 and December 2003 were studied.


RESULTS
Some 144 operations were analysed; 51 patients had critical ischaemia and 93 claudication. There was one postoperative death (0.7 per cent). Complications occurred within 30 days in 32 patients (22.2 per cent), including graft occlusion in three (2.1 per cent); six patients (4.2 per cent) required early reoperation. Primary patency for patients with critical ischaemia was 88, 82 and 74 per cent at 1, 3 and 5 years respectively. Respective figures for those who presented with claudication were 93, 92 and 90 per cent (P = 0.034). Late symptoms included graft occlusion (20 patients), disease progression (25), ongoing ulceration (six), graft infection (nine), false aneurysm formation (two) and late donor-site stenosis (two).


CONCLUSIONS
When obtaining informed consent, simply describing patency and limb salvage rates does not provide an accurate picture of the outcome of femorofemoral grafting.
Pursell
R
R
Department of Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK.
Sideso
E
E
Magee
T R
TR
Galland
R B
RB
D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000401:mortality / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency