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An Overview Of Iliofemoral Bypasses At A Single Institution
Josephine A. Gottsponer, B.S.1, Mohammed M. Moursi, M.D.
2.
1University of Arkansas for Medical Sciences, Little Rock, AR, USA,
2Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
ABSTRACT:Objective: To evaluate outcomes, and the conditions contributing to those, of all iliofemoral bypasses performed by a single surgeon at a single institution including outcome analysis throughout the life of the patient
Methods: Data was collected from patients undergoing iliofemoral bypass at a single institution under one surgeon from 1996 – 2021. Data included information about pre-operative disposition, intra-operative methods, and post-operative complications and outcomes. Major endpoints included survival, length of follow-up, follow-up procedures required, and patency rates.
Results: In 127 iliofemoral bypasses, 97% of patients were male, and age ranged from 46 – 82 with an average of 63.6±7. The most common comorbidities were cigarette smoking (81% current,15% former), hypertension (72%), and hyperlipidemia (39%). Half of patients were taking an anticoagulant or antiplatelet medication, most commonly aspirin (n = 62, 49%). Preoperative ABI’s of the limb ranged from 0 – 0.75 (mean 0.38±0.15) with an average post-op increase from the preoperative ABI of 0.3749. Intraoperative conditions appear in Table 1.
Table 1. Intraoperative Conditions | | | | | | | | | | | | | | |
| Proximal Anastomosis | Distal Anastomosis | |
| CIAa | EIAb | IIAc | CFAd | PFAe | SFAf | |
| Number (n) | 97 | 27 | 3 | 107 | 20 | 1 | |
| Percent (%) | 76.4 | 21.2 | 2.4 | 83.5 | 15.6 | 0.7 | |
| Graft Type | Graft Diameter | |
| Number (n) | Percent (%) | | Number (n) | Percent (%) | |
| Ringed PTFEg | 123 | 96.8 | 7 mm | 1 | 0.8 | |
| Non-Ringed PTFE | 1 | 0.8 | 8 mm | 120 | 94.5 | |
| Gore Hybrid | 1 | 0.8 | 9 mm | 1 | 0.8 | |
| Gore Propaten | 2 | 1.6 | 10 mm | 5 | 3.9 | |
| | | Number (n) | Percent of All Patients (%) |
| Patients with Secondary Ipsilateral Procedures | 88 | 69.3 |
| Patients with Secondary Contralateral Procedures | 6 | 4.7 |
| Ipsilateral Secondary Procedure | Number (n) | Percent of Ipsilateral Secondary Procedures (%) |
| Endarterectomy | 75 | 59.5 |
| Distal Bypass | 18 | 14.2 |
| Proximal Stent | 5 | 3.9 |
| Profunda-Focused Interventions | 13 | 10.3 |
| aCommon iliac artery, bExternal iliac artery, cInternal iliac artery, dCommon femoral artery, eProfunda femoris artery, fSuperficial femoral artery, gPolytetrafluoroethylene |
30-day mortality was 1.6%. Average length of follow-up after primary bypass was 57±57 months; average survival post-op was 80 ± 58 months. Postoperative ABI’s ranged from 0.33 – 1.16 (mean 0.76±0.23). 72% of patients were discharged on aspirin, 8% on clopidogrel, and 6% on warfarin. The initial iliofemoral bypass graft failed during follow-up in 24% of patients. The most common reason for failure was occlusion (94% of failed grafts). Seven patients (6.5%) underwent subsequent ipsilateral amputation. 1- and 5-year primary patencies were 69% and 38.2%. 1- and 5-year primary-assisted patencies were 86.7% and 81.8%. 1- and 5-year secondary patencies were 95.7% and 63.2%.
Conclusions: Bypass with close follow-up and early reintervention to prevent graft failure results in 5-year patency over twice that of bypass alone at 81.8%. This is a relatively expedient solution to iliac and femoral artery disease and, with follow-up and early reintervention, could be the mainstay of treatment. The long duration of follow-up afforded to this study will allow it to serve as an excellent point of comparison against the patencies of other treatment modalities such as iliac stenting, femorofemoral bypass, and axillary-femoral bypass.
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