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1 FF1 19 FF vs 88 vs 56 p =.4 8mm vs 6mm 91 vs p =.4 S vs C 89 vs 39 p =.1 6mm 8mm 9 FF 8mm FF PTA STENT TASC 3cm Tel: FF FF
2 Survival rate 1 Graft patency rate secondary 84.7 primary years years Fig. 1 Cumulative survival rate (A), primary and secondary graft patency rate (B) in 45 patients undergoing FF bypass graft. Ten-year survival rate was A B Y 2 FF 1FontaineFontaine II Fontaine IV Fontaine II 32 III 6 IV eptfe 17 Dacron EXS 1 Gelsoft ERS CC 9 S S mm 2 8 mm mmHg PTA PTA 1 1 FF 6 Kaplan-Meier 2 Logrank testp < Fig
3 24 8 FF Claudicants 87.7 Threat Limb 56.4 (p=.41) Externally supported 95.7 No external support 33.3 (p=.132) y Fig. 2-1 Comparison of primary graft patency rates after FF bypass in patients undergoing surgery for claudication with that in patients who underwent operation for limb-threatening ischemia y Fig. 2-2 Comparison between secondary patency rates of bypass grafts performed with externally supported graft material and unsupported graft material PTA 1 FF 1 FF PTA Fontaine p =.4 Fig eptfe DacronEXS Gelsoft ERS p =.132 Fig SC S p =.1) Fig mm 8 mm mm p = mm p =.3 Fig FF PTAPTA FF 2 ABI
4 S type 88.6 C type 38.9 (p=.19) mm graft 91 6 mm graft (p=.4) y y Fig. 2-3 Comparison between primary patency rates of bypass grafts anastomosed by inverted C configuration and italic S configuration. Fig. 2-4 Comparison between primary patency rates of bypass grafts performed with 8 mm diameter graft and 6 mm diameter graft. Table 1 Long-term resuts of femorofemoral crossover bypass patients operative Motarity() Survival () 1 yrs primary patency () 1 yrs Dick et al. 19 7) Plecha et al ) Chang ) 75 Fahal et al ) Farber et al ) Hayakawa et al ) Dokou et al ) Mingoli et al ) Toshima et al FF FF FF p =.59 FF Table FF FF 1 FF
5 24 8 FF1 3 1 FF FF Mingoli Farber 1 6 mm mm mm 2 FF 8 mm S C 24C C S C C S Mingoli 13 Ricco 16 C S Fahal 1 C Plecha 8 C Hanafy 17 SFF FF ABI S FF FF 6 14 FF run off FF Kalman 3 FF ABI.61 ABI.6 2 Fontaine III 23
6 13 5 run off 6 mm 8 mm 9 FF 8 mm FF FF 8 mm 1 Fahal, A. H., McDonald A. M. and Marston A.: Femorofemoral bypass in unilateral iliac artery occlusion. Br. J. Surg., 76: 22-25, Rutherford, R. B., Patt A. and Pearce, W. H.: Extra-anatomic bypass: A closer view. J. Vasc. Surg., 6: , Kalman, P. G., Hosang, M., Johnston, K. W., et al.: The current role for femorofemoral bypass. J. Vasc. Surg., 6: 71-76, TASC working group: Management of peripheral arterial disease. J. Vasc. Surg. suppl., 31: S215-S217, 2. 5 Walker, P. J., Harris, J.P. and May, J.: Combined percutaneous transluminal angioplasty and extraanatomic bypass for symptomatic unilateral iliac artery occlusion with contralateral iliac artery stenosis. Ann. Vasc. Surg., 5: , Perler, B. A. and Williams, G. M.: Does donor iliac artery percutaneous transluminal angioplasty or stent placement influence the results of femorofemoral bypass? analysis of 7 consecutive cases with long-term follow-up. J. Vasc. Surg., 24: , Dick, L. S., Brief, D. K., Alpert, J., et al.: A 12-year experience with femorofemoral crossover grafts. Arch. Surg., 115: , Plecha, F. R. and Plecha, F. M.: Femorofemoral bypass grafts: Ten-year experience. J. Vasc. Surg., 1: , Chang, J. B.: Current state of extraanatomic bypasses. Am. J. Surg., 152: 22-25, Farber, M. A., Hollier, L. H., Eubanks, R., et al.: Femorofemoral bypass: A profile of graft failure. South. Med. J., 83: , extra-anatomical bypass (femoro-femoral graft) , , Mingoli, A., Sapienza, P., Feldhaus, R. J., et al.: Femorofemoral bypass grafts: factors Influencing long-term patency rate and outcome. Surgery, 129: , Harrington, M. E., Harrington, E. B., Haimov, M., et al.: Iliofemoral versus femorofemoral bypass: The case for an individualized approach. J. Vasc. Surg., 16: , Defraigne, J. O., Vazquez, C. and Limet, R.: Crossover iliofemoral bypass grafting for treatment of unilateral iliac atherosclerotic disease. J. Vasc. Surg., 3: 693-7, Ricco, J. B.: Unilateral iliac artery occlusive disease: A randomized multicenter trial examining direct revascularization versus crossover bypass. Ann. Vasc. Surg., 6: , Hanafy, M. and McLoughlin, G. A.: Comparison of iliofemoral and femorofemoral crossover bypass in the treatment of unilateral iliac arterial occlusive disease. Br. J. Surg., 78: 11-12, da Gama, A.D.: The fate of the donor artery in extraanatomic revascularization. J. Vasc. Surg., 8: , V. A. Cooperative Study: Donor limb vascular events following femoro-femoral bypass Surgery. Arch. Surg., 126: , ,
7 24 8 FF1 Long-term Results of Femorofemoral Crossover Bypass Masahiro Toshima*, Takeshi Konuma, Hiroaki Yusa, Shuuichi Hoshino and Yasushi Nishiya Department of Thoracic and Cardiovascular Surgery, Toyama Prefectural Central Hospital (*at present, Department of Vascular Surgery, Kamiichi General Hospital) Key words: Femorofemoral bypass, Graft diameter, Donor iliac angioplasty, 1-year patency We investigate the long-term results of femorofemoral crossover bypass and examine the significance of this operation in the era of endovascular treatment. In the past 19 years, 45 patients with a mean age of 66 years have undergone femorofemoral crossover bypass grafting for symptomatic iliac arterial occulusive disease. The over all 1-year survival rate was 52, and the 1-year primary and secondary patency rates were 81 and 85, respectively. The 1-year primary patency rates were siginificantly different in preoperative symptom (claudication 88 vs critical ischemia 56, p =.4), anastomosis type (S figure 89 vs Reversed C figure 39, p =.1), and graft diameter (8mm 91 vs 6mm, p =.4). The difference was not significant in the factors of combined donor iliac artery endovascular procedure, graft material, and infrainguinal run-off. By stepwise analysis of the primary patency rate, a 6mm-diameter graft has about a 9 times higher occlusion hazard compared with an 8mm-diameter graft. It is necessary to use a 8mm-diameter graft in femorofemoral crossover bypass grafting and the indications of this operation can be broadened to include claudication and bilateral iliac arterial disease suitable for donor iliac artery endovascular treatment. Jpn. J. Vasc. Surg., 13: , 24 25
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