Extra-anatomic bypasses for aortoiliac disease in high-risk patients.

A series of 75 patients, with an average age of 65 years, underwent the following extra-anatomic bypasses involving the crossover femorofemoral principle: femorofemoral (F-F), 54 patients; aortofemorofemoral (A-F-F), 12 patients; common iliac-femorofemoral (CI-F-F), six patients; and axillofemorofemoral (Ax-F-F), three patients. Fifty eight of the 75 patients (77 percent) initially presented with rest pain or gangrene. The operative mortality rate in this high-risk group of patients was 4 percent. Analysis by the life-table method showed the graft patency rate to be 91.1 percent at one year and 87.4 percent at 18 months. There have been no graft failures or deaths in the series of 20 patients followed longer than 18 months. Two amputations followed graft failures and nine of the remaining 11 amputations were done in patients with patent grafts during the same period of hospitalization, reflecting the severity of their gangrene upon admission. High-risk patients who are not suitable for crossover F-F grafts without an inflow procedure may be suitable for a CI-F-F or A-F-F bypass before being considered for an Ax-F-F bypass.