Durability of cross-femoral grafts after aortic graft XXXX : the fate of autogenous conduits.

@entity1 @entity254 @entity281 @entity10194 @entity439 @entity715 @entity850
PURPOSE: Revascularization for the treatment of aortic graft @entity281 is usually accomplished by remote prosthetic axillofemoral bypass combined with cross-femoral bypass. When @entity281 at the femoral level precludes placement of a prosthetic cross-femoral graft, we have used a variety of autogenous tissue conduits to restore circulation to the contralateral leg. To determine which of these conduits offers the most durable reconstruction, we have reviewed 78 @entity1 treated for aortic graft @entity281 . METHODS: Between 1980 and 1991 we used either autogenous saphenous vein (ASV, n = 34), endarterectomized superficial femoral artery ( @entity10194 , n = 14), or direct ilioiliac @entity254 (iliac, n = 10) to provide cross-femoral flow. We compared the performance of these tissue conduits with a concurrent @entity1 group with aortic graft @entity281 in whom a prosthetic cross-femoral graft was used (prosthetic, n = 20). RESULTS: Follow-up was available for 98.7% of @entity1 , average 3.8 +/- 2.9 years, and was not different between the four groups. Bleeding complications occurred exclusively in the ASV group (n = 3, 8.8%) and were all in the perioperative period. In addition one ASV and one iliac conduit developed multiple false @entity439 . Hemodynamic conduit failure ( @entity715 or @entity850 ) occurred in nine (26.5%) ASV conduits, six (42.8%) @entity10194 conduits, and one iliac conduit, but not in the prosthetic group. When all of these adverse events were combined for each conduit group, both ASV and @entity10194 conduits had a higher rate of conduit failure when compared with the prosthetic conduits (p < 0.05, log-rank test). Limb loss resulting from cross-femoral conduit failure occurred in six (17.6%) @entity1 in the ASV group, four (28.6%) @entity1 in the @entity10194 group, and one @entity1 each in the iliac and prosthetic groups. These differences were not significant. CONCLUSIONS: We conclude that ASV and @entity10194 conduits do not provide stable long-term cross-femoral revascularization and should be regarded as bridge grains until @entity281 is eradicated. When @entity281 mandates their use, frequent postoperative conduit surveillance is required. If ASV or @entity10194 caliber is marginal, consideration should be given to the use of a larger autogenous conduit, such as superficial femoral vein.
