Combined Angioplasty and Femorofemoral Bypass in the Treatment of Unilateral Iliac Arterial Occlusive Disease

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.

Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve / 대한구급학회지

Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.

Patency Rates of Femorofemoral Bypass: Effects of Concomitant Leg Arterial Bypass

Femorofemoral bypass was chosen as a primary(n=71) and redo (n=7) procedures for 78 patients with unilateral iliac artery occlusive disease during the period of 4 and a half years at the Department of Surgery, Kyungpook National University Hospital. The patients were categorized into 3 groups according to the patency of the superficial femoral artery on the recipient-side leg and the performance of concomitant leg arterial bypass: Group I (n=34), patent superficial femoral artery (SFA); Group II (n=19), occluded SFA left untreated; Group III (n=25), occluded SFA treated with leg arterial bypass. Adjuvant procedures during the femorofemoral bypasses included 16 femoral endarterectomies, 5 donor-side iliofemoral interposition grafts, and 4 donor-side iliac balloon angioplasties. The primary cumulative patency rates for all femorofemoral bypasses at 1, 2, 3, and 4 years were 96.3%, 84.7%, 84.7%, and 74.2%, respectively calculated by the life table method. The primary patency rates were 90.0%, 62.9%, 62.9%, 62.9% in Group II and 95.7%, 89.5%, 89.5%, 89.5% in Group III at 1, 2, 3, and 4 years after bypass grafting. The statistical analysis with log rank test to compare the patency rates between Group II and III revealed no significant (p=0.2425) differences. In summary, femorofemoral bypass was a durable bypass procedure for the patients with unilateral iliac artery occlusion. Further follow-up is required to confirm the effects of concomitant leg arterial bypass to the patency of femorofemoral bypass.