Cross Pubic Femoro-femoral Artery Bypass with Great Saphenous Vein / 대한혈관외과학회지

PURPOSE: The purpose of this study was to evaluate the great saphenous vein (GSV) as a conduit for crossover femoro-femoral bypass. Generally the conduit for crossover femoro-femoral bypass is a synthetic material because of the acceptable long-term patency and low complication rates. But, as the average life expectancy becomes extended, a better patency rate becomes more important. In this study, we compared the patency rates and hemodynamic results between crossover femoro-femoral bypass operations with GSVs and those with synthetic grafts. METHODS: From 1998 to 2008, 119 femoro-femoral bypass operations were done. Among them, 38 femoro-femoral bypass used GSV as a conduit (group I) and 79 operations used expanded polytetrafluoroethylene (group II). Two cases used arm veins and we excluded those cases. RESULTS: The 3 year primary patency rate of total cases was 75.1%, 93.7% in group I and 66.1% in group II. There were no statistical differences in hemodynamic results such as peak systolic velocity, volume flow and ankle/brachial systolic pressure index between the two groups. CONCLUSION: The 3 year primary patency rate of group I was better than that of group II. However there were no differences in hemodynamic changes. So GSV is recommended as a conduit for crossover femoro-femoral bypass especially in young patients who are eager to have longer patency rates after surgery instead of less invasive endovascular therapy.

Femoro-femoral Cardiopulmonary Bypass during Tracheal Reconstruction Surgery: A case report / 대한마취과학회지

A 45 year-old-women with tracheal stenosis due to an endotracheal tumor was scheduled for tracheal reconstruction surgery. The stenotic lesion was located 1 cm above the carina, and was length of 4 cm and had a narrowest internal diameter of 0.4 cm. The length of such a stenotic segment and its narrowest internal diameter may pose lung ventilation problems before or during tumor resection, which may preclude a successful outcome. Thus, during tracheal reconstruction surgery a femoro-femoral partial cardiopulmonary bypass, self respiration, and pulmonary artery ligation were used. These measures improved oxygenation and cardiovascular stability, and tracheal reconstruction was successfully performed without complication.

Patency Rates of Femoro-Femoral Bypass Graft

PURPOSE AND METHOD: To access the value and results of femoro-femoral bypass for the treatment of unilateral iliac artery occlusion, the clinical data of 53 patients who underwent femoro-femoral bypass graft at Yeungnam University Hospital between January 1994 to December 2000 were analyzed retrospectively. The influence of several variables (such as, age, sex, preoperative symptom, risk factors and associated medical illness, status of distal artery, preoperative ABI) on the long term patency was evaluated by univariate statistical analysis. RESULT: The patients were 47 males and 6 females ranging from 37 to 84 years of age. The mean age was 65, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. Associated diseases were hypertension in 28 cases (52.8%), diabetes mellitus in 10 cases (18.8%), cardiac disease in 19 cases (32.0%) and cerebrovascular disease in 4 cases (7.5%). History of smoking was noted in 77.4% of the cases. Focal stenosis of donor site iliac artery has been found in 2 cases and combined distal outflow occlusion has been found in 21 cases. 2 donor site iliac artery ballon angioplasty was performed preoperatively and 14 adjuvant procedures (9 femoro-popliteal bypass, 2 femoro-tibial bypass, 3 profundoplasty) was performed simultaneously during the operation. Cumulative 1, 3, 5,-year primary and secondary patency rates of all femoro-femoral bypass were 87.0%, 76.6%, 68.1% and 91.7%, 85.7%, 73.5%. There was no operative mortality and major perioperative complications. Univariate analysis showed that the patients without distal arterial occlusion had significantly better 1-, 3- and 5-year primary patency rates (93.0%, 89.0% and 74.2% versus 76.6%, 45.9% and 45.9%, P=0.02) compared with the patients with distal arterial occlusion. No significant effect was exerted by all other variables on long term results. CONCLUSION: These results suggest that femoro-femoral bypass is a safe and durable operation that results in good patency in a good runoff.

Causes of Recurrent Leg Ischemia and Graft Occlusion after Crossover Femoro-femoral Bypasses (FFBs)

With increasing number of high-risk, advanced atherosclerotic patients, crossover femoro-femoral bypass (FFB) became commonly chosen extra-anatomic bypass for symptomatic iliac artery occlusive disease. But the causes FFB graft failure have not been clarified yet. PURPOSE: We aimed to investigate the natural course of native artery disease, the causes of graft occlusion and recurrent leg ischemia after FFBs. METHOD: Among 162 primary FFBs for atherosclerotic iliac occlusive disease, 45 patients who underwent follow-up arteriography for recurrent ischemic symptom were enrolled. We investigated the interval changes between initial preoperative and follow-up angiograms and categorized them as inflow, outflow and/or graft lesions. The significant changes between 2 angiograms was arbitrarily defined as progression of lesion into stenosis >50% or occlusion. And the patients were divided into 2 groups as patent FFB group and occluded FFB group. We compared interval changes on angiograms between patient and occluded FFB groups to find out any difference and tried to determine the ultimate causes of recurrent leg ischemia considering not only the interval changes but the preexisting, untreated leg arterial lesions. RESULT: The follow-up angiography was most commonly performed within 1 year after FFB with mean interval of 21.2 +/- 21.6 months. Interval changes between 2 angiograms were 24 (53.3%) FFB grafts occlusion, 8 (17.8%) inflow iliac disease progression, and 26 (57.8%) ouflow arterial occlusion. Comparing the interval changes between patent and occluded FFB groups, the significantly higher frequency of outflow occlusion was noted in occluded FFB group (75% vs 38.1%, P=0.012). The most common finding on follow-up angiongram responsible for the recurrent ischemia was also outflow arterial occlusion even in patent FFB group. CONCLUSION: The most common cause of graft occlusion and recurrent leg ischemia was outflow arterial occlusion after FFB.

2 Cases of Aortoiliac Disease Treated with Strecker Stent Followed by Femoro-Femoral Bypass Graft

In the treatment of aortoiliac disease, two methods could be considered. One is percutaneous transluminal angioplasty, and the other is bypass graft. However sometimes two methods could be combined in high risk patients with a lengthy unilateral occlusion of one iliac artery and less extensive obstruction of the contralateral one, since higher risk aortofemoral bypass surgery may be obviated by femoro-femoral bypass graft after percutaneous treatment of the less diseased iliac artery. We report two cases of arortoiliac disease treated with Strecker stent followed by femoro-femoral bypass graft.

2 Cases of Aortoiliac Disease Treated with Strecker Stent Followed by Femoro-Femoral Bypass Graft

In the treatment of aortoiliac disease, two methods could be considered. One is percutaneous transluminal angioplasty, and the other is bypass graft. However sometimes two methods could be combined in high risk patients with a lengthy unilateral occlusion of one iliac artery and less extensive obstruction of the contralateral one, since higher risk aortofemoral bypass surgery may be obviated by femoro-femoral bypass graft after percutaneous treatment of the less diseased iliac artery. We report two cases of arortoiliac disease treated with Strecker stent followed by femoro-femoral bypass graft.

Anesthetic Management for Surgery of the Descending Aortic Aneurysm / 대한마취과학회지

The rupture of the aorta commonly follows major blunt truma to the thorax. It was markdly increased in recent years, paralleling the rising number of vehicular accidents, The patient underwent surgical repair with femoro-femoral partial bypass 40 days after injury. The anesthesia for descending aortic surgery presented problems involving large hemodynamic alterations during thoracic aortic cross-clamping, protection of the heart and brain from large increases in pressure occuring above the cross clamp, and prevention of spinal cord and renal ischemic damage below the cross-clamp. One lung ventilation was also employed with this anesthetic technique. A 23 years old male patient with traumatic aneurysm of descending thoracic aorta was treated successfully.