Autologous and synthetic pediatric iliofemoral reconstruction: a novel technique for pediatric iliofemoral artery reconstruction

Abstract

Pediatric lower extremity arterial catheterization-related injuries can result in significant long-term morbidity. Revascularization is challenging due to concerns for long-term patency and growth accommodation with synthetic grafts. We describe a novel technique for iliofemoral revascularization using common iliac artery transposition and bridging polytetrafluoroethylene grafts. We treated two children who underwent femoral catheterization resulting in lifestyle-limiting claudication. Both patients experienced immediate resolution of symptoms. Postoperative imaging demonstrated widely patent vasculature. ASPIRE (autologous and synthetic pediatric iliofemoral reconstruction) is a method of pediatric iliofemoral artery revascularization that allows for an autologous artery to span the hip joint, reducing graft thrombosis risk and accommodating patient growth.

Keywords: Iliofemoral reconstruction; Novel technique; Pediatric revascularization.

Fig 1

A, Patient 1 developed an occluded left external iliac artery (EIA) with an unaffected contralateral iliac system. D,E, The stenotic left EIA was resected. The common iliac artery (CIA) was ligated distal to the aortic bifurcation and transposed under the inguinal ligament, where an end-to-side anastomosis was performed between the transposed CIA and the common femoral artery (CFA). A polytetrafluoroethylene (PTFE) graft was anastomosed in an end-to-end fashion to bridge the gap between the aortic bifurcation to the transposed CIA. B, Postoperative imaging demonstrated widely patent bilateral lower extremity vasculature. C, At the 5-year follow-up, the previously oversized PTFE conduit appears to be of appropriate diameter and length. IIA, Internal iliac artery; SFA, superficial femoral artery.

Fig 2

A, Patient 2 had bilateral external iliac artery (EIA) occlusion, which necessitated preservation of at least one internal iliac artery (IIA) to maintain pelvic perfusion. D,E, The stenotic EIAs were resected. Both common iliac arteries (CIAs) were ligated just distal to the aortic bifurcation and rotated caudally under the inguinal ligament. End-to-side anastomoses were performed between the rotated CIAs and the common femoral arteries (CFAs). To bridge the gap between the aortic bifurcation to the rotated CIAs, a polytetrafluoroethylene (PTFE) graft was anastomosed in an end-to-end fashion on each side. B,C, Postoperative imaging demonstrated widely patent bilateral lower extremity vasculature.