title: Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results.
abstract: BACKGROUND
  To assess our current practice concerning the indications and the immediate and midterm results of femorofemoral bypass.
  
  
  METHODS
  We retrospectively included all patients, from 1997 to 2008, operated on for aortoiliac occlusive disease using an extra-anatomical bypass from a donor iliac artery or a femoral artery to the contralateral femoral artery (common or profunda artery). Demographic data, initial clinical status, characteristics of the interventions, and short- and midterm results were collected. Elective surgery was distinguished from urgent surgery (critical limb ischemia, acute ischemia, vascular infection).
  
  
  RESULTS
  One hundred twenty-four femorofemoral bypasses were performed (103 male), mean age 68 (±12) years. Indications were critical limb ischemia (47.1%), intermittent claudication (38.8%), acute ischemia (12.1%), and vascular infections (1.7%). Perioperative outcomes were 5.6% mortality (elective surgery 0.0%, urgent surgery 9.7%, P = 0.02) and 27.4% morbidity without any secondary graft infections (elective surgery 22.5%, urgent surgery 31.9%, P = 0.17). Mean follow-up period was 3 years, and overall survival was 69.4% (elective surgery 88.7%, urgent surgery 56.7%, P = 0.08). At 3 years, primary patency was 81.8% and secondary patency was 89.3% (elective surgery 96.4%, urgent surgery 84.2%, P = 0.68). No significant risk factors for immediate and secondary thromboses were found.
  
  
  CONCLUSIONS
  In our current practice, femorofemoral bypasses are applied mainly for urgent procedures when avoiding a direct aortic approach is mandatory, with good midterm results. Although indications are limited for good-fit patients, femorofemoral bypass has confirmed safety (no perioperative deaths, no infections) and high durability (good secondary patency).
authors: Vascular Surgery Unit, University Hospital of Besancon, Besancon, France. srinckenbach@chu-besancon.fr
authors: Simon
authors: S
authors: Rinckenbach
authors: Nicolas
authors: N
authors: Guelle
authors: Julien
authors: J
authors: Lillaz
authors: Mazen
authors: M
authors: Al Sayed
authors: Vincenzo
authors: V
authors: Ritucci
authors: Gabriel
authors: G
authors: Camelot
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005602:France; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D007383:Intermittent Claudication / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency