Comparison of femorofemoral and aortofemoral bypass for aortoiliac occlusive disease

Background Role and results of femorofemoral bypass grafting, usually reser ved to high-risk patients affected with unilateral iliac artery occlusion, are still debated. Methods. Experimental design: retrospective clinical study. Settings: Unive rsity Hospital. Patients: seventy-six high-risk patients (group 1) who unde rwent a primary expanded polytetrafluoroethylene (ePTFE) externally support ed femorofemoral bypass graft were retrospectively compared to two addition al groups of patients selected from the entire series of patients who under went an aortobifemoral bypass graft. Patients of group 2 (n=80) were random ly chosen to determine differences in risk factors, associated diseases, pr evious abdominal operations, operative indications, preoperative findings a nd outcome. Patients of group 3 (n=50) were matched for sex, risk factors, associated diseases, previous abdominal operations, operative indications a nd preoperative findings with those of group I to assess the importance of the type of operation in determining the outcome of the procedure. Results. Postoperative mortality (6, 4 and 6%, respectively), 5-year primar y and secondary patency (71, 80, 83% and 80, 87, 87%, respectively) and lim b salvage rates (78, 87 and 87%, respectively) were similar among the group s (p=NS, p=NS, p=NS, respectively). Five-year survival rate of group 2 was significantly better than that of group 1 and 3 (p<0.04 and p<0.04, respect ively). Conclusions. Primary ePTFE externally supported femorofemoral bypass graft in high-risk patients is safe and produces long-term results similar to aor tofemoral reconstruction.