Autogenous Femoral-Femoral Crossover Bypasses: A Viable Option in Cases of Prosthetic Infection
William E. Raible, III, MD1, Hayley Chang2, Chin-Chin Yeh, MD3, Benjamin B. Chang, MD3, Jeffrey C. Hnath, MD3, Sean P. Roddy, MD3, Paul B. Kreienberg, MD3, R. Clement Darling, III, MD3.
1Albany Medical College, Albany, NY, USA, 2University of Rochester, Rochester, NY, USA, 3The Vascular Group, Albany, NY, USA.
Objective: Patients presenting with infected femoral inflow and/or outflow prosthetic reconstruction present a difficult clinical dilemma. One option is an autogenous femoral-femoral crossover bypass. This retrospective study analyzes the effectiveness of autogenous femoral-femoral crossover bypasses. Methods: A retrospective chart review from a prospectively collected vascular procedure registry of patients who underwent autogenous femoral-femoral crossover bypasses between January 1, 2002 and September 30, 2016 was performed. Existing prosthetic graft infection was the primary indication for use of autogenous conduit. Follow up involved serial examination and noninvasive studies at six-month intervals. Patients who underwent femoral-femoral bypasses with synthetic grafts were excluded from this study. Results: Over the 14-year period studied, 814 femoral-femoral crossover bypasses were performed, of which 29 (3.56%) were autogenous. Eighteen (62.1%) of the crossovers were performed for existing prosthetic infection, whereas 11 (37.9%) were performed for recurrent prosthetic thrombosis. Greater saphenous vein was the most commonly used conduit (13/18, 72.2%), followed by lesser saphenous vein (3/18, 16.7%) and spliced vein (2/18, 11.1%). Over a mean followup of 39 months, patients with this vascular repair had a mean patency of 29.4 months. There were no cases of graft infection. Conclusions: In selected cases of infected femoral-femoral prosthetic reconstruction, the use of autogenous femoral-femoral crossover bypass can be utilized with good results. The relative resistance of autogenous bypass to infection allows it to be used successfully in cases in which there may be a higher chance for graft contamination.
Back to 2017 Program