Aortobifemoral bypass, the gold standard: technical considerations.

The controversies that surround the technical aspects of transabdominal reconstruction for aortoiliac occlusive disease, and more specifically ABF, have provided lively debates during the golden era of vascular surgery. It seems almost a pity that, with the resolution of many of these issues, what has become one of the most effective and durable procedures that vascular surgeons have to offer has been beset by PTA and stents on the one side, and a resurgence of extra-anatomic bypass on the other. Hopefully, the coming era of outcome assessment and cost-benefit analysis, coupled with continued advances in perioperative care, will sustain it in its rightful position, as the procedure of choice for bilateral aortoiliac occlusive disease.