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The Journal of Cardiovascular Surgery 2001 June;42(3):381-7

language: English

Comparison of femorofemoral and aortofemoral bypass for aortoiliac occlusive disease

Mingoli A., Sapienza P., Feldhaus R. J., Di Marzo L., Burchi C., Cavallaro A.

From the Depart­ment of Sur­gery Creighton Uni­ver­sity, ­Omaha, NE, USA and *Depart­ment of Sur­gery ''­Pietro Val­doni'' Uni­ver­sity of ­Rome ''La ­Sapienza'', ­Rome, ­Italy


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Back­ground. ­Role and ­results of fem­o­rof­e­moral ­bypass ­grafting, usu­ally ­reserved to ­high-­risk ­patients ­affected ­with uni­lat­eral ­iliac ­artery occlu­sion, are ­still ­debated.
­Methods. Experi­mental ­design: ret­ro­spec­tive clin­ical ­study. Set­tings: Uni­ver­sity Hos­pital. ­Patients: sev­enty-six ­high-­risk ­patients (­group 1) who under­went a pri­mary ­expanded poly­tet­ra­flu­o­roe­thy­lene (­ePTFE) exter­nally sup­ported fem­o­rof­e­moral ­bypass ­graft ­were ret­ro­spec­tively com­pared to two addi­tional ­groups of ­patients ­selected ­from the ­entire ­series of ­patients who under­went an aor­to­bif­e­moral ­bypass ­graft. ­Patients of ­group 2 (n=80) ­were ran­domly ­chosen to deter­mine dif­fer­ences in ­risk fac­tors, asso­ciated dis­eases, pre­vious abdom­inal oper­a­tions, oper­a­tive indi­ca­tions, pre­op­er­a­tive find­ings and out­come. ­Patients of ­group 3 (n=50) ­were ­matched for sex, ­risk fac­tors, asso­ciated dis­eases, pre­vious abdom­inal oper­a­tions, oper­a­tive indi­ca­tions and pre­op­er­a­tive find­ings ­with ­those of ­group 1 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 pri­mary and sec­on­dary ­patency (71, 80, 83% and 80, 87, 87%, respec­tively) and ­limb sal­vage ­rates (78, 87 and 87%, respec­tively) ­were sim­ilar ­among the ­groups (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, respec­tively).
Con­clu­sions. Pri­mary ­ePTFE exter­nally sup­ported fem­o­rof­e­moral ­bypass ­graft in ­high-­risk ­patients is ­safe and pro­duces ­long-­term ­results sim­ilar to aor­tof­e­moral recon­struc­tion.

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