Revascularization of the occluded donor artery of a femorofemoral crossover by axillary bypass.

In patients over 70 years of age with disabling leg ischaemia, femorofemoral crossover bypass with an externally supported polytetrafluoroethylene (PTFE) graft is the treatment of choice for unilateral occlusion of the iliac artery. Over a 6-year period, 18 elderly patients underwent femorofemoral bypass, six of whom had received percutaneous transluminal angioplasty before surgery for stenosis of the contralateral external iliac artery (donor artery). Symptoms of ischaemia recurred in three patients because of deterioration of the donor iliac artery more than 2 years after surgery, although all three grafts were well visualized by angiography. Revascularization was attempted in these three patients by an axillary bypass. Disabling symptoms of ischaemia were completely relieved by this procedure, although two patients underwent reoperation 9 and 16 months after the axillary bypass respectively. All three patients are now free from symptoms of ischaemia. It is concluded that: deterioration of the donor iliac artery after femorofemoral bypass does occur, although it has been considered unlikely because of decreased peripheral resistance; in spite of complete occlusion of the donor artery, grafts remain patent, proving the excellent antithrombogenic activity of externally supported PTFE; and revascularization using additional axillary bypass is a feasible procedure in such cases.