Skip to Main Content

++

PATIENT STORY

++

A 61-year-old man presented to his primary care physician complaining of worsening intermittent claudication of the right hip, buttock, and calf while trying to walk half a block. Upon further questioning the patient also admitted waking up in the middle of the night because of throbbing pain in his right toes. Significant findings on physical examination were absence of femoral and distal pulses of the right lower extremity. He also had evidence of muscle atrophy of the right calf. The left lower extremity had a normal palpable femoral pulse.

++

Ankle-brachial indices (ABIs) confirmed the presence of severe ischemia of right lower extremity with index of 0.4. Computed tomographic arteriogram (CTA) confirmed occlusion of the right common iliac and the right external iliac artery (Figure 7-1).

++
FIGURE 7-1

Computed tomographic (CT) angiogram illustrating occlusion of the right iliac system indicated by the red bracket.

Graphic Jump Location
++

This patient was seen by a vascular surgeon and because of severe claudication and developing rest pain, an extra-anatomic femoral—femoral artery bypass surgery was recommended.

++

He underwent uneventful left to right femorofemoral bypass surgery, during which blood flow from his left iliac artery was redirected to the right lower extremity (Figure 7-2).

++
FIGURE 7-2

Left to right femorofemoral bypass (arrow) redirecting the blood flow from the left iliac system to the right lower extremity.

Graphic Jump Location
++

GENERAL CONCEPTS

++

  • Aortofemoral bypass remains the standard against which all extra-anatomic bypass surgeries' methods of reconstruction for distal aortic occlusion and iliac artery occlusion must be measured.1

  • The term extra-anatomic bypass applies to any bypass graft that is placed in a site different from that of the native arterial segment being bypassed. While many common vascular procedures such as femorotibial bypass might be considered extra-anatomic, this term specifically describes procedures addressing diseases of the aortoiliac and femoral arteries.1

  • Common extra-anatomic bypasses include axillofemoral and femorofemoral bypasses. Less common and more complex bypasses include obturator, thoracofemoral, and supraceliac-to-iliofemoral bypasses.

  • Historically, extra-anatomic procedures were developed to treat high-risk patients with severe medical comorbidities or with "hostile" abdomens. "Hostile" abdomen refers to patients with prior multiple abdominal operations that result in adhesions ("frozen" abdomen) or patients with active intra-abdominal infections (including "mycotic" aortic aneurysms, infected aortic prostheses, aortoenteric fistulae). "Hostile" groin refers to patients with infected femoral artery aneurysm, prosthetic graft groin infection, history of groin radiation, and malignancies involving the groin or femoral vessels.

  • Extra-anatomic bypasses require a long, subcutaneously placed prosthetic graft. These grafts are often externally supported with a removable continuous-spiral coil to reduce kinking and compression. Commonly used grafts are ePTFE and Dacron grafts.1

++

INDICATIONS FOR INTERVENTION

++

Two primary indications for ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessCardiology Full Site: One-Year Subscription

Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessCardiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.