Femorofemoral bypass graft: choice or compromise?

Thirty-one femorofemoral crossover graft procedures were performed in 27 patients who had unilateral limb ischemia either due to unilateral aortoiliac occlusive disease of due to thrombosis of one of the limbs of a previously placed aortic bifurcation graft. There was no operative mortality, and only two patients required late amputation. There have been two late deaths. Thrombosis of the femorofemoral graft occurred in five patients. Four patients had a second femorofemoral graft, three of whom have long-term patency. Grafts are patent in 23 of 25 surviving patients. The femorofemoral graft procedure is relatively simple and is associated with a low operative mortality and morbidity. Its late patency rates are comparable with those following conventional aortic bifurcation graft procedures. Therefore, we believe the indications for femorofemoral graft should be broadened to include all patients with unilateral aortoiliac occlusive disease where anatomic conditions are favorable and there is unilateral occlusion of an aortic bifurcation graft.