Extra-Anatomical Bypass Operation in Patients with Unilateral Graft Limb Occlusion after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Antoniaz R, Jukberg S, Omera M and Sceria M

Published on: 2023-01-19

Abstract

Background and Objectives: The objective of our study was to determine the durability of an extra-anatomical procedure in the form of a femorofemoral crossover bypass in patients with abdominal aortic aneurysm who had a unilateral graft limb occlusion following endovascular aneurysm repair.

Materials and Methods: From January 2001 to March 2021, 1611 patients with AAA were treated with EVAR using a bifurcated stent-graft at the Department of General, Endocrine and Vascular Surgery at the Independent Public Central Clinical Hospital in Warsaw, Poland. The patients were included in the study continuously and all primary procedures carried out were elective.

Results: The current study included 33 high-risk patients (2.05%), ASA class III & IV, (30 men; mean age 70 ± 7.7 years, range 48-90) who required an extra-anatomical procedure. Seven patients had a failed femorofemoral crossover bypass which occluded during the follow-up period. Five patients had a thrombectomy, one patient had an above-the-knee amputation, and one patient was treated conservatively. However, four patients experienced femorofemoral crossover bypass re-occlusion. Two patients required another re-intervention and the remaining two patients were treated conservatively.

Conclusion: The femorofemoral crossover bypass as an extra-anatomical procedure following unilateral graft limb occlusion should be considered for high-risk patients who are not a candidate for major surgery.