Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia

T. Ohki, M. L. Marin, F. J. Veith, R. T. Lyon, L. A. Sanchez, W. D. Suggs, J. G. Yuan, R. A. Wain, R. E. Parsons, A. Patel, S. P. Rivers, Jacob Cynamon, C. W. Bakal, R. C. Darling, J. R. Youkey, F. Jarrett, D. Calcagno

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions. Methods: Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized lilac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed. Results: All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 ± 3 mm to 30 ± 7 mm and from 6 ± 2 mm to 26 ± 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). Conclusions: Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.

Original languageEnglish (US)
Pages (from-to)984-997
Number of pages14
JournalJournal of Vascular Surgery
Volume24
Issue number6
DOIs
StatePublished - 1996

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Ischemia
Extremities
Transplants
Iliac Artery
General Anesthesia
Epidural Anesthesia
Thigh
Hematoma
Sutures
Stents
Aorta
Thrombosis
Necrosis
Arteries
Hemodynamics
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Ohki, T., Marin, M. L., Veith, F. J., Lyon, R. T., Sanchez, L. A., Suggs, W. D., ... Calcagno, D. (1996). Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia. Journal of Vascular Surgery, 24(6), 984-997. https://doi.org/10.1016/S0741-5214(96)70044-7

Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia. / Ohki, T.; Marin, M. L.; Veith, F. J.; Lyon, R. T.; Sanchez, L. A.; Suggs, W. D.; Yuan, J. G.; Wain, R. A.; Parsons, R. E.; Patel, A.; Rivers, S. P.; Cynamon, Jacob; Bakal, C. W.; Darling, R. C.; Youkey, J. R.; Jarrett, F.; Calcagno, D.

In: Journal of Vascular Surgery, Vol. 24, No. 6, 1996, p. 984-997.

Research output: Contribution to journalArticle

Ohki, T, Marin, ML, Veith, FJ, Lyon, RT, Sanchez, LA, Suggs, WD, Yuan, JG, Wain, RA, Parsons, RE, Patel, A, Rivers, SP, Cynamon, J, Bakal, CW, Darling, RC, Youkey, JR, Jarrett, F & Calcagno, D 1996, 'Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia', Journal of Vascular Surgery, vol. 24, no. 6, pp. 984-997. https://doi.org/10.1016/S0741-5214(96)70044-7
Ohki, T. ; Marin, M. L. ; Veith, F. J. ; Lyon, R. T. ; Sanchez, L. A. ; Suggs, W. D. ; Yuan, J. G. ; Wain, R. A. ; Parsons, R. E. ; Patel, A. ; Rivers, S. P. ; Cynamon, Jacob ; Bakal, C. W. ; Darling, R. C. ; Youkey, J. R. ; Jarrett, F. ; Calcagno, D. / Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia. In: Journal of Vascular Surgery. 1996 ; Vol. 24, No. 6. pp. 984-997.
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abstract = "Purpose: Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions. Methods: Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized lilac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed. Results: All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 ± 3 mm to 30 ± 7 mm and from 6 ± 2 mm to 26 ± 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). Conclusions: Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.",
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T1 - Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia

AU - Ohki, T.

AU - Marin, M. L.

AU - Veith, F. J.

AU - Lyon, R. T.

AU - Sanchez, L. A.

AU - Suggs, W. D.

AU - Yuan, J. G.

AU - Wain, R. A.

AU - Parsons, R. E.

AU - Patel, A.

AU - Rivers, S. P.

AU - Cynamon, Jacob

AU - Bakal, C. W.

AU - Darling, R. C.

AU - Youkey, J. R.

AU - Jarrett, F.

AU - Calcagno, D.

PY - 1996

Y1 - 1996

N2 - Purpose: Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions. Methods: Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized lilac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed. Results: All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 ± 3 mm to 30 ± 7 mm and from 6 ± 2 mm to 26 ± 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). Conclusions: Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.

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