Trans-osseous ilio-femoral by-pass. A new extra-anatomical by-pass.

A new extra-anatomical by-pass is described as an alternative procedure to solve complicated vascular problems in the groin. This trans-osseous ilio-femoral by-pass can be use in spite of classical extra-anatomical by-passes (obturator, perineal, supra-pubic, axillo-femoral). The proximal anastomosis can be performed on aorto-iliac homolateral axis by a retro-peritoneal approach. The by-pass is going externally on the psoas-iliac muscle, through the iliac aisle and then between the sartorius and gluteus medius muscle. Distal anastomosis can be performed on the profunda femoral artery or, with sequential by-pass, on multiple arteries of the leg. We have performed such a by-pass in 5 patients for femoral triangle infection (4 cases) or radiotherapeutic complication. One patient died after cardiac surgery, another has had a major amputation. Three by-passes are patent with a follow-up period of 2 years. This by-pass is easy to do, its route is short, deep (without neurological, bleeding or compressive risk) and far from an eventual infected common femoral artery.