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

ABSTRACT

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.