ENDOVASCULAR AORTOUNIFEMORAL GRAFTS AND FEMOROFEMORAL BYPASS FOR BILATERAL LIMB-THREATENING ISCHEMIA

Purpose: Although axillobifemoral bypass procedures have a lower morta lity rate than aortobifemoral bypass procedures, they are limited by d ecreased patency moderate hemodynamic improvement, and the need for ge neral anesthesia. This report describes an alternative approach to bil ateral aortoiliac occlusive disease using unilateral endovascular nort ofemoral bypass procedures in combination with standard femorofemoral reconstructions. Methods: Seven patients who had bilateral critical is chemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascu lar grafts, which were inserted into predilated, recanalized iliac art eries. The proximal end of the endovascular graft was fixed to the dis tal aorta or common iliac artery with a Palmaz stent. The distal end o f the graft was suture-anastomosed to the ipsilateral patent outflow v essel, and a femorofemoral bypass procedure was then performed. Result s: All endovascular grafts were successfully inserted through five occ luded and two diffusely stenotic iliac arteries under either local (1) , epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9+/-3 mm to 30+/-7 mm and from 6/-2 mm to 26+/-4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely re solved. procedural complications were limited to one local wound hemat oma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). Conclusions: Endovascular iliac grafts in combination wit h standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aort oiliac occlusive disease, particularly when bilateral axillary-subclav ian disease is present.