Herman J. Zandvoort1, Ellen D. Kaan1, Jean-Paul P. de Vries2, Frans L. Moll1, Joost A. van Herwaarden1
1University Medical Center Utrecht, Utrecht, The Netherlands; 2St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
OBJECTIVES: Femorofemoral crossover bypasses (FFCB) are used in both patients with unilateral iliac artery occlusive disease (IAOD) and in patients with aortoiliac aneurysms (AIA) treated with an aorto-uni-iliac stent graft. The purpose of this study is to evaluate the durability and effectiveness of a femorofemoral crossover bypass for patients with aneurysmal and stenotic arterial disease.
METHODS: All patients treated with FFCB for aneurysmal or stenotic arterial disease from 2001 to 2011 in 2 Dutch tertiary vascular referral hospitals were included. Data were retrospectively reviewed.
RESULTS: Ninety-five patients were included. The AIA group consisted of 48 patients (median age 78 years, IQR 72-84; 36 men) and the IAOD group consisted of 47 patients (median age 71, IQR 63-77; 35 men). Twenty-six of 48 patients in the AIA group (54%) were treated for ruptured aneurysms. In the IAOD group Fontaine classification was as follows: II 60%, III 21% and IV 19%. Traditional cardiovascular risk factors were comparable between both groups. Median follow-up was 19 months (IQR 1-41) in the AIA group and 28 months (IQR 14-50) in the IAOD group. Primary patency after 2 years was 90% for the AIA group and 79% for the IOAD group (p=0.3). Secondary patency rates were respectively 100% and 95% (p=0.4).
Overall one-year mortality was in the AIA group 10% for non-ruptured aneurysms and 54% for ruptured aneurysms and was in the IAOD group 13%. In 6 AIA patients (13%) bypass related complications were reported (5 stenoses/occlusions requiring percutaneous transluminal angioplasty (PTA) or thromboendarterectomy (TEA) and 1 bypass infection) vs. 15 patients (32%) with bypass related complications in the IAOD group (4 bypass infections, 2 wound infections, 8 stenoses or occlusions requiring PTA/TEA (n=7) or removal (n=1) and 1 ischemic leg) (p<0.05).
CONCLUSIONS: Femorofemoral bypasses have comparable patency rates for aneurysmal and occlusive disease. However, bypass related complications are more often seen in IAOD patients.
AUTHOR DISCLOSURES: J. P. de Vries, Nothing to disclose; E. D. Kaan, Nothing to disclose; F. L. Moll, Nothing to disclose; J. A. van Herwaarden, Nothing to disclose; H. J. Zandvoort, Nothing to disclose.
Posted April 2012