Femorofemoral bypass to the deep femoral artery for limb salvage after prior failed percutaneous endovascular intervention.

Background: To report the long-term results and clinical outcomes of femorofemoral bypass (FFB) to deep femoral artery (DFA) after failed endovascular attempts in treating critical limb ischemia (CLI) caused by long total occlusion of the unilateral iliofemoral artery. Methods: A retrospective review was conducted on 82 consecutive patients (59 men, 23 women; mean age: 73.2 years), who presented with CLI and underwent FFB to DFA performed by a single surgeon. Preoperative and postoperative ankle-brachial index (ABI), runoff blood flow velocities, and long-term patency rates were analyzed, and the clinical and surgical variables influencing the graft, patency were assessed. Results: The mean ABI rose from 0.19 +/- 0.17 preoperative to 0.54 +/- 0.18 postoperative (P < 0.001). The postoperative blood flow velocities of popliteal arteries (30.74 +/- 11.62 cm/sec) and tibial arteries (21.36 +/- 8.59 cm/sec) were significantly higher than the preoperative values (13.96 +/- 7.62 cm/sec and 9.83 +/- 5.46 cm/sec). At 1, 5, and 10 years, the primary, assisted, and secondary patency rates were 90.3%, 58.5%, and 12.2%; 91.9%, 66.0%, and 45.9%; and 98.4%, 85.1%, and 61.6%, respectively. By multivariate analysis, the graft patency rate was positively related with hypertension but negatively correlated with hypercholesterolemia and single patent tibial runoff. Conclusions: Our data suggest that FFB to DFA can be a safe, effective, and durable method for the treatment of CLI after prior failed endovascular attempts.