Femorofemoral bypass graft: analysis of patency and factors influencing long-term outcome

Abstract

Purpose: To evaluate the results of femorofemoral bypass graft (FFBPG), we analyzed 110 consecutive FFBPGs performed at our institution during an 11-year period.

Methods: In 62 (56%) patients the indication for surgery was claudication and in 48 (44%) patients rest pain or tissue loss. In 42 patients the superficial femoral artery (SFA) was occluded. A preoperative percutaneous transluminal balloon angioplasty (PTA) was performed in 24 (22%) patients to correct a significant donor iliac artery stenosis. In 48 (44%) patients a total of 54 arterial procedures were performed simultaneously with FFBPG.

Results: After surgery 75 (68%) patients were moderately or markedly improved, whereas 20 (18%) were minimally improved, unchanged, or worse, including 7 (6%) with hemodynamic failures. The in-hospital mortality rate was 4.5%. Actuarial patient survival rate was 70% +/- 8.6% at 6 years. The actuarial primary graft patency rate was 83% +/- 4.2% at 1 year, 71% +/- 6.9% at 3 years, 60% +/- 8.3% at 5 years, and 51% +/- 9.6% at 6 years. Age, sex, and race of the patient did not influence graft patency. Grafts placed for limb-threatening ischemia or in patients with SFA occlusion had a similar patency rate compared with those placed for claudication or in patients with patient SFA. The overall limb preservation rate was 83% +/- 7.3% at 5 years but was only 64% for patients who underwent operation for limb-threatening ischemia.

Conclusions: In conclusion, FFBPG offers moderately low long-term patency in a population with limited survival. Outflow procedures performed concomitantly with FFBPG seemed to compensate for the negative impact on graft patency rate of ipsilateral SFA occlusion and limb-threatening ischemia. Limb-threatening ischemia, however, carried a significantly higher (p < 0.05) amputation rate. The influence of preoperative donor iliac artery percutaneous transluminal balloon angioplasty on FFBPG patency remains unclear.