Femorofemoral bypass grafts: Factors influencing long-term patency rate and outcome

Background. Crossover femorofemoral bypass graft (CFFBG) was proposed in th e early days of modern vascular surgery to treat patients affected with uni lateral iliac artery disease who were a high surgical risk. We investigated factors influencing short- and long-term outcomes of CFFBG. Methods. The study was designed as a retrospective clinical study in a univ ersity hospital setting with a base of 228 patients. Of these patients, 154 (67.5 %) presented a high surgical risk. The indication for operation was limb-threatening ischemia in 188 (82.5 %) patients. All patients underwent CFFBG. The procedure was performed in 150 patients as the primary operation and in 78 patients after previous vascular graft failure or infection, or both. A preoperative percutaneous transluminal angioplasty was performed in 57 patients (25 %) to correct donor iliac artery disease. In 127 patients (55.7 %), an associated vascular procedure was performed to improve the out flow. Postoperative complications; 5- and 10-year primary, secondary, and l imb salvage rates, and factors influencing short- and long-term results wer e assessed. Results. Thirteen (5.7 %) postoperative deaths occurred. Postoperative mort ality and morbidity rates were significantly higher in patients aged more t han 65 years (7.9 % versus 3.5 % and 18.6 % versus 6.1 %, respectively, P < .03). Primary and secondary patency rates at 5 and 10 years were 70.2 % an d 48.1 %, 82.8 % and 63.2 %, respectively; 5- and 10-year limb salvage and survival rates were 85.5 % and 80.1 %, 63.3 % and and 31.0 %, respectively. Ten-year primary and secondary patency and limb salvage rates were signifi cantly lower when the procedure was performed after previous vascular graft failures (50.2 % versus 26.5 %, P < .007; 74.1 % versus 44.1 %, P < .01; a nd 84.3 % versus 72.5 %, P < .03, respectively). Five- and 8-year patency r ates of autogenous vein CFFBG (34.3 % and 22.8 %, respectively, P < .03) we re significantly lower than those of expanded polytetrafluoroethylene (71.1 % and 59.8 %, respectively) and polyester (77.3 % and 50.3 %, respectively ) CFFBG. Moreover, 5- and 10-year primary and secondary patency rates were significantly better when externally supported grafts were used as compared with those without external support (80.1 % and 69.9 % versus 61.1 % and 2 1.1 %, P < .01; 88.8 % and 75.9 % versus 78.9 % and 45.4 %, P < .05, respec tively. Multivariate analysis showed that the only variable associated with low primary and secondary patency and limb salvage rates was the operation performed after previous vascular graft failures (P < .04, P < .03 and P < .05, respectively). Conclusions. CFFBG allows early and long-term results similar. to those obt ained with reconstructions originating from the aorta when it is performed as a primary operation when an adequate outflow is provided and externally supported prosthetic material is used.