Crossover iliofemoral bypass grafting for treatment of unilateral iliac atherosclerotic disease

Purpose: In patients with unilateral iliac disease, a less invasive procedu re than aortobifemoral bypass grafting may be desirable, especially in poor -risk patients or when sexual dysfunction is feared. In these cases, femoro femoral (FF) bypass grafting is often proposed. Compared with PF bypass gra fting, iliofemoral (IF) bypass grafting avoids bilateral exposure of the gr oins, which may reduce the risk of infection. When the primitive iliac arte ry is occluded from its origin or heavily calcified, one may use the contra lateral artery as inflow, after a small retroperitoneal exposure, to perfor m a crossover iliofemoral (CIP) bypass grafting procedure, through the Retz ius space. Our 10-year experience with CIP bypass grafting in a select grou p of patients was studied. Methods: Between 1986 and 1996, 36 patients underwent CIF bypass grafting f or symptomatic unilateral iliac occlusion or stenosis. All patients were ex amined by means of Doppler ultrasound scanning and underwent bilateral mult iplane angiography. Patients were considered for this procedure when the ip silateral common iliac artery was occluded from its origin or was diffusely and heavily calcified. The decision to perform a CIF bypass grafting proce dure was made when no significant disease of the contralateral. common ilia c artery was seen, and patients who had features of contralateral iliac dis ease were excluded. The main outcomes were perioperative mortality and morb idity, longterm primary and secondary patency rates, and limb salvage rate. Results: The study included 31 men and five women, with a mean age of 58.8 years. Indications for bypass grafting were disabling claudication (26 of 3 6 patients, 72%) and limb-threatening ischemia (10 of 26 patients, 28%). Tw elve procedures were performed simultaneously: endarterectomy of the recipi ent common femoral artery (n = 3), femoropopliteal bypass grafting (n = 4, 11.1%), profundoplasty (n = 4, 11%), and right internal carotid endarterect omy (n = 1). New postoperative erectile dysfunction did not develop in any of the patients. The survival rate was 97.3% at 1 year and 68.5% at 5 years . The primary and secondary patency rates were 94% and 100%, respectively, at 1 year and 76.7% and 95%, respectively, at 5 years. The limb salvage rat e was 100% at 1 year and 87% at 3 years. Conclusion: The operative mortality associated with CIF is low. The long-te rm primary and secondary patency rates are satisfactory, and they are lower than those reported for aortobifemoral bypass grafting. This procedure doe s not preclude a later performance of an aortobifemoral bypass grafting pro cedure. CIF bypass grafting is not only suitable for poor-risk patients wit h a limited life expectancy who have the appropriate arterial anatomy, but also may be warranted for young patients in whom erectile dysfunction is fe ared.