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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 patientMethods: 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 AnastomosisDistal Anastomosis
Number (n)97273107201
Percent (%)76.421.22.483.515.60.7
Graft TypeGraft Diameter
Number (n)Percent (%)Number (n)Percent (%)
Ringed PTFEg12396.87 mm10.8
Non-Ringed PTFE10.88 mm12094.5
Gore Hybrid10.89 mm10.8
Gore Propaten21.610 mm53.9
Number (n)Percent of All Patients (%)
Patients with Secondary Ipsilateral Procedures8869.3
Patients with Secondary Contralateral Procedures64.7
Ipsilateral Secondary ProcedureNumber (n)Percent of Ipsilateral Secondary Procedures (%)
Distal Bypass1814.2
Proximal Stent53.9
Profunda-Focused Interventions1310.3
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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