Role of femorofemoral crossover bypass grafting for unilateral iliac atherosclerotic disease: A comparative evaluation with anatomic bypass

Purpose. To assess the role of femorofemoral or iliofemoral crossover bypass grafting, the early and late results of crossover bypasses were reviewed and compared with those of anatomic bypasses. Methods. The clinical records of 164 patients with arteriosclerosis obliterans who underwent 99 crossover bypasses and 65 anatomic ones from 1982 to 2002 were retrospectively evaluated. The early and late results including operative mortality and morbidity, graft patency rate, limb salvage rate, and survival rate of the patients as well as backgrounds of the patients were compared between the two kinds of bypass procedures. In addition, perioperative factors including bypass procedures affecting graft patency were evaluated by a multivariate analysis. Results. The percentage of high-risk patients was higher in the crossover bypass group than in the anatomic bypass group. The operative mortality and morbidity were similar between both bypass groups. The primary and secondary patency rates of crossover bypass grafts (93% and 97%, 83% and 92%, and 65% and 63% at 2, 5, and 10 years, respectively) were lower than those of anatomic ones (95% and 98%, 93% and 98%, and 90% and 98% at 2, 5, and 10 years, respectively). The late survival of the patients in the crossover bypass group was significantly lower than that in the anatomic bypass group. A multivariate analysis revealed the operative method, namely the crossover bypass, to be the only significant risk factor of late graft failure. Conclusion. A crossover bypass was thus determined to be an acceptable procedure only in high-risk patients with a limited life expectancy.