J L Mills1, S M Taylor, R M Fujitani. 1. University of South Florida School of Medicine, Division of Vascular Surgery, Tampa 33606.
Abstract
PURPOSE: Although the deep femoral artery (DFA) is well acknowledged as an outflow vessel for inflow reconstruction, data are lacking concerning the suitability of the DFA as an inflow site for distal bypass. METHODS: From 1986 to 1992 we performed 268 consecutive infrainguinal reversed vein bypasses, of which 56 (21%) originated from the middle or distal DFA. The indications for DFA-origin grafts included inadequate vein length, need for concomitant extended profundaplasty, and avoidance of groin scarring from previous reconstruction or infection. The surgical approach to the DFA (standard, posteromedial, or lateral) was tailored to the patient. All grafts were monitored with serial duplex scanning surveillance. RESULTS: Primary and secondary patency rates of DFA origin grafts were 78% and 96% at 3 years. These patency rates were no different from those grafts originating from the common femoral artery (66%; 89%), the superficial femoral artery (69%; 87%), or the popliteal artery (66%; 87%). Hemodynamic failure was detected in seven DFA-origin grafts, but only one resulted from disease in the common femoral artery or DFA proximal to the origin of the vein graft. CONCLUSIONS: Direct lateral and posteromedial approaches to the DFA were used extensively in repeat operative situations, avoiding dissection in a scarred groin and shortening the length of vein required to perform an autogenous bypass. We conclude that in appropriately selected patients, the DFA origin technique increases the versatility of lower extremity vein bypass grafting without sacrificing durability.
PURPOSE: Although the deep femoral artery (DFA) is well acknowledged as an outflow vessel for inflow reconstruction, data are lacking concerning the suitability of the DFA as an inflow site for distal bypass. METHODS: From 1986 to 1992 we performed 268 consecutive infrainguinal reversed vein bypasses, of which 56 (21%) originated from the middle or distal DFA. The indications for DFA-origin grafts included inadequate vein length, need for concomitant extended profundaplasty, and avoidance of groin scarring from previous reconstruction or infection. The surgical approach to the DFA (standard, posteromedial, or lateral) was tailored to the patient. All grafts were monitored with serial duplex scanning surveillance. RESULTS: Primary and secondary patency rates of DFA origin grafts were 78% and 96% at 3 years. These patency rates were no different from those grafts originating from the common femoral artery (66%; 89%), the superficial femoral artery (69%; 87%), or the popliteal artery (66%; 87%). Hemodynamic failure was detected in seven DFA-origin grafts, but only one resulted from disease in the common femoral artery or DFA proximal to the origin of the vein graft. CONCLUSIONS: Direct lateral and posteromedial approaches to the DFA were used extensively in repeat operative situations, avoiding dissection in a scarred groin and shortening the length of vein required to perform an autogenous bypass. We conclude that in appropriately selected patients, the DFA origin technique increases the versatility of lower extremity vein bypass grafting without sacrificing durability.