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Contralateral Femoral Artery Inflow For Lower Extremity Infra-inguinal Revascularization
Daniel T. Harris, MD
1, Steven Leers, MD
2,
David Stonko, MD3, Thomas Reifsnyder, MD
4.
1Johns Hopkins, Baltimore, MD, USA,
2UPMC, Pittsburgh, PA, USA,
3Johns Hopkins, Manchester, MD, USA,
4Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Objective: Patients with infra-inguinal limb threatening ischemia and a hostile ipsilateral groin, present a difficult challenge for revascularization. A seldom mentioned but elegant solution is to use of the contralateral femoral artery for inflow. The purpose of this study was to evaluate a series of six patients who had contralateral femoral artery inflow for infra-inguinal bypass. Furthermore, whether this procedure necessitates a large amount of additional conduit was investigated.
Methods: A chart review of six patients who underwent lower extremity revascularization using contralateral femoral artery inflow was conducted. Clinical characteristics including pre- and post-ABIs, patency and complications were assessed. Subsequently, 50 randomly selected aortograms performed between 2016 to 2021 were reviewed. A straight-line measurement was made between the common femoral arteries just proximal to the femoral bifurcations. This was used as an approximation for the amount of additional conduit required to use contralateral femoral artery inflow.
Results: Six patients with a median age of 63 (50-77) underwent lower extremity revascularization with contralateral femoral artery inflow. Four patients had presenting symptoms of rest pain, one with a non-healing foot wound, and one patient with acute limb ischemia. Three patients had contraindications to ipsilateral bypass, with occlusion of the common, superficial and deep femoral arteries, one with prior radiation therapy, one with a large open groin wound, and one with an infected common femoral prosthetic patch. Preoperative ankle brachial indices ranged from 0 to 0.39 (mean 0.14, standard deviation 0.2); post-operative indices ranged from 0.7 to 1 (mean 0.9, standard deviation 0.2). The outflow artery was popliteal for four patients, distal PT for one, and AT for one patient. Two patients suffered post-operative wound complications, but there were no major limb or cardiac issues. Patency and follow up ranged from 1.2 to 8.5 years (mean 3.4, standard deviation 2.8). There were two bypass thrombosis (2 years and 8.5 years); one thrombosis eventual required amputation. Average femoral-femoral distance for women was 14.1 cm (standard deviation 1.0 cm) and men 14.5 cm (standard deviation 0.6 cm).
Conclusions: Contralateral femoral artery inflow for infra-inguinal bypass is a simple viable solution for an ipsilateral hostile groin. This small series suggests that this option can provide long-term patency while utilizing only a small amount of additional conduit.
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