Iliofemoral bypass: A 10-year review

Iliofemoral bypass is available to patients with unilateral iliac occlusive disease. Experience with iliofemoral bypass in terms of graft patency and patient outcome is reviewed. From January 1981 to February 1991, iliofemoral grafts were placed in 19 patients. Of these, 16 had medical records available for review; all were men and the mean age was 65 (range 46–72) years. Risk factors associated with peripheral vascular disease included tobacco use (16 patients), hypertension (ten), coronary artery disease (seven) and diabetes mellitus (four). Six patients had undergone previous peripheral vascular procedures. Angiography revealed an ipsilateral iliac artery suitable for bypass. Indications for operation included claudication (five patients), rest pain (six) and non-healing ulcer or gangrene (five). Ten bypasses were placed on the left and six on the right. The mean(s.d.) ankle: brachial pressure Index before operation was 0.39(0.24): 0.55(0.19) in patients with claudication and 0.29(0.22) in those treated for threat of limb loss. After surgery patients with claudication demonstrated improvement of this index to a mean(s.d.) of 0.83(0.24); in those with threat of limb loss it improved to 0.60(0.16). One wound infection resolved with antibiotic therapy alone. Two patients had early (< 30 days) graft failure leading to amputation and subsequent perioperative death. Three other grafts failed, one each at 8, 9 and 13 months. All five grafts failed in patients with preoperative threat of limb loss. The cumulative patency rate was 72% at 1 year and 64% at 2–5 years. It is concluded that: iliofemoral bypass is an alternative procedure in patients with unilateral iliac occlusive disease: graft failures occurred early and resulted in low patency rates: the perioperative mortality rate was high, which perhaps reflects the medical condition of patients before surgery: and iliofemoral bypass should be reserved for patients with unilateral iliac occlusive disease that cannot be treated by transluminal angioplasty and who are not candidates for aortofemoral bypass because of pre-existing medical illness.