Unilateral or crossover iliofemoral bypass is an attractive alternative to aortobifemoral bypass for aortoiliac occlusive diseases

Introduction: Iliofemoral bypass (IFB) as an alternative to aortofemoral bypass (AFB) has been advocated for patients with unilateral iliac occlusion. The purpose of this study is to evaluate treatment outcomes of IFB and AFB for patients with aortoiliac occlusive disease in two teaching institutions.
Methods: Over a ten-year period, patients undergoing IFB were examined and compared to those who underwent ABF with matched age and co-morbidities. Clinical presentations and treatment outcomes were analyzed.
Results: Twenty-three patients including five patients with prior abdominal surgeries underwent elective IFB. During the same period, patients who underwent retroperitoneal AFB (RP-AFB, n=23) or transabodminal AFB (TA-AFB, n=23) were compared. Six patients (26%) in the IFB group comparing to six patients (13%) in the AFB groups presented with limb-threatening ischemia. There was no difference in age and medical co-morbidities among the three groups. IFB and RP-AFB groups had significant shorter hospital stay and nasogastric tube requirement than TA-AFB group (P<0.05). Additionally, IFB group had significant less ICU stay (0.7day) and operative blood loss (200cc) comparing to RP-AFB group (2.2days and 874cc) and TA-AFB group (3.8 days and 719cc, P<0.001). Although there was no perioperative mortality among all three groups, IFB group had less overall 30-day complications comparing to AFB groups. During a mean follow-up of 38 months, three patients in IFB group and one in the TA-AFB group died of non procedure-related etiologies, and there was no difference in late complication or patency rate among three groups.
Conclusion: Our study demonstrated that IFB is an attractive alternative for patients with unilateral iliac occlusive diseases. This approach is associated with favorable perioperative morbidity and satisfactory long-term outcomes.