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Is There Still A Role For Femoral-Femoral Artery Bypass In The Current Endovascular World?
Miriam Meghnagi, M.S., Huong Truong, M.D. RPVI.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
OBJECTIVES: Aortoiliac occlusive disease (AIOD) is defined as the chronic accumulation of atherosclerotic plaques. The effects of AIOD can threaten patients’ limbs and lives. In recent years, endovascular revascularization has become increasingly used as an alternative to open bypass surgery. Although open surgery is a durable and effective option, endovascular approaches have become more favorable for patients who have a high surgical risk. The objective of this study is to compare the patency rates and peri- and post-operative complication risks of femoral-femoral artery bypass (FFB) and iliac arteries kissing stents (KS) for unilateral AIOD, and to help predict which procedure would be more appropriate for specific patient populations.
METHODS: Retrospective chart review from a single institution vascular surgery department was conducted on patients with unilateral AIOD treated with either FFB or KS between 2011 and 2020 with indications for claudication, rest pain, and tissue loss with ages ranging from 18-90. Re-interventions were evaluated further via retrospective chart review. We performed chi-square and t-test using R-statistical software to evaluate the procedures in relation to patient’s demographics, post-operative complications, and patency rates.
RESULTS: 64 patients were evaluated in this cohort. The mean age was 72 with patients in the FFB group being older (average 76), with a statistically significant rate of males undergoing FFB (51%) vs KS (48%). Patients who underwent FFB had statistically significant higher rate of hypertension (95%), whereas patients in KS group had higher rates of coronary artery disease (33%). In terms of operative complications, there was a higher rate in the FFB group at 6%. At the 1-month ABI/PVR follow-up, patients who underwent FFB had a higher patency rate than KS group.
CONCLUSIONS: Although open surgery is a durable and effective method for the treatment of unilateral AIOD, femoral-femoral artery bypass is an extra-anatomic bypass with lower patency. Therefore, we will compare this type of extra-anatomic bypass versus endovascular techniques using kissing iliac artery stents to help guide the revascularization method for this subset of disease. Arterial bilateral kissing iliac artery stents have higher patency rate and fewer complications as compared to the bypass group and should be considered as the primary treatment option for unilateral AIOD.
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