Femorofemoral Arterial Bypass: Subcutaneous or Preperitoneal

Abstract

A salutary, long-term result, using preperitoneal placement in a patient transferred after repeated failure of subcutaneous prosthetic femorofemoral bypass, prompted a review of this procedure by the authors. From 1972 to 1996, 61 men and 1 woman, aged 28 to 80 years, received 67 initial or “redo” interpositions for unilateral, predominately-sinistral ischemia, 45% being operated on as emergencies. They were considered unfit for the preferred direct transabdominal reconstruction under general anesthesia because of cardiopulmonary comorbidity. Follow up, extending to 20 years, was complete in 93.5%. Operative mortality was 6.6%, all from cardiogenic shock after atherothromboembolism secondary to transfemoral intraaortic balloon pulsation after myocardial infarction (MI) or coronary artery bypass graft (CABG). Most bypasses were subcutaneous; however, 17% were preperitoneal. The author's cumulative initial patency was similar for those operated on with primary (23) and postaortofemoral bypass graft (post-AFBG) (29) ischemia. Preperitoneal placement (10) was associated with better primary prosthetic patency and less infection than subcutaneous (42) insertion.