title: Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients.
abstract: OBJECTIVE
  Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis.
  
  
  METHODS
  Five patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described.
  
  
  RESULTS
  After extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died-three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding.
  
  
  CONCLUSIONS
  The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.
authors.affiliation: Division of Urology and Division of Vascular Surgery, Teaching Hospital of the State University of Campinas, Campinas, Brazil.
authors.forename: Ubirajara
authors.initials: U
authors.lastname: Ferreira
authors.forename: Leonardo Oliveira
authors.initials: LO
authors.lastname: Reis
authors.forename: Lia Yumi
authors.initials: LY
authors.lastname: Ikari
authors.forename: Walter
authors.initials: W
authors.lastname: da Silva
authors.forename: Wagner Eduardo
authors.initials: WE
authors.lastname: Matheus
authors.forename: Fernandes
authors.initials: F
authors.lastname: Denardi
authors.forename: Rafael Mamprim
authors.initials: RM
authors.lastname: Stopiglia
authors.forename: Fábio Husseman
authors.initials: FH
authors.lastname: Menezes
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000473:pathology*; D012501:Saphenous Vein / Q000637:transplantation; D019043:Vascular Neoplasms / Q000556:secondary* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods