Femoral-Femoral Bypass for Limb Salvage to Correct Common Iliac Occlusion after Lower Extremity Trauma

Background Roadway injuries are a leading cause of lower extremity vascular trauma. Treating these injuries involves controlling life-threatening hemorrhage and restoring distal perfusion. Materials and Methods We describe a unique presentation of chronic iliac artery occlusion in the setting of blunt trauma requiring extra-anatomic bypass for maximal limb salvage. Results A 50-year-old male presented after a pedestrian versus auto accident. He had mangled bilateral lower extremities and was taken emergently for lower extremity amputations. He was found to have chronic left common iliac occlusion and a femoral-femoral bypass was performed to assist with healing his left below-the-knee amputation Discussion Lack of adequate perfusion can cause poor outcomes in limb salvage. This case demonstrated that lower extremity trauma can be complicated by chronic vascular disease. Reperfusion and adequate wound healing can be accomplished by using bypass grafting after more traditional reperfusion techniques fail.

COMPARATIVE STUDY OF FEMORO-FEMORAL CROSSOVER BYPASS AND AORTO-UNIFEMORAL BYPASS

Iliac artery occlusions can produce Chronic limb-threatening ischemia and these patients need early revascularization procedures for their limb salvage which is usually established by Aorto-unifemoral bypass. But in patients with poor general conditions femoro-femoral crossover bypass is an alternate option. Ours is Comparative study of Femoro-femoral crossover bypass and Aorto-unifemoral bypass in patients with Iliac occlusion and Chronic limb-threatening ischemia. Total of 22 patients were included in which femorofemoral bypass performed in 10 patients and Aorto-unifemoral bypass in 12 patients. Indications for femorofemoral bypass were poor cardiac/respiratory functions and old age with poor performance. Stable patients were subjected to Aorto-unifemoral bypass. Patency rates and limb salvage rate were 100% with no perioperative mortality in both of these procedures. This shows femorofemoral bypass is an effective revascularization procedure in patients with Iliac occlusion and Chronic limb-threatening ischemia with associated poor general conditions.

A study on surgical intervention outcomes in chronic aorto iliac occlusion

Background: Aorto-iliac occlusion is an advanced and late manifestation of the atherosclerotic vascular disease. Patients with this complicated and frequently multi-level disease can present with debilitating symptoms ranging from life-limiting claudication to limb-threatening ischemia. To study the results of Surgical management and complications of Aortic surgery in a patient with chronic, aortoiliac occlusion.Methods: Our study of 22 cases, 12 patient underwent aortic bi femoral bypass, 08 cases underwent aortobi-iliac bypass and 2 of them aortic endarterectomy. This entire patient had a 64 slice CT angiogram of aorto with bilateral lower limb and offered surgical treatment after explaining the risk and complication of surgery. All patients followed post op with the clinical examination, ABI, duplex once a month.Results: 19 patients had a patent graft at the end of the study period. The primary patency of 86%. 2 patient had graft thrombectomy, 1 patient had graft thrombectomy with extension bypass, hence the secondary patency was 95%.Conclusions: The spectrum of aortoiliac occlusive disease ranges from short, simple stenosis to long, complete occlusions, with treatment options that vary accordingly from minimally invasive endovascular procedures to major open surgical intervention.