Sandeep Raj Pandey
Current Position
Consultant Vascular & Endovascular
Annapurna / Norvic
Peripheral Artery Session

Topic: Femorofemoral crossover bypass(FCB) on unilateral iliac artery occlusive disease


Femorofemoral bypass is a method of surgical revascularisation by insertion of a prosthetic or vein graft between the femoral arteries to bypass an occluded or injured iliac artery.
•Symptomatic lower-extremity ischemia due to acute or chronic occlusion of a unilateral IA.
•Adjunct to an endovascular unilateral AI exclusion of an AAA
•Unavailability of endovascular options for management of iliac occlusive disease
•High-risk patients with significant comorbidities that preclude in-line reconstruction with inflow from the proximal IA or the A
•Compromised inflow AI arterial segment
•Significant obesity that may cause unfavorable graft geometry
•Extreme medical risks for surgery
•Femoral nerve injury •Hematoma
•Graft thrombosis and distal emboli •Graft infection •Bladder injury
case 1
•A 66 yr chronic smoker old lady with left lower limb severe claudication & rest pain with 3 toes & ankle ganrene. CTA:CTO of left iliac A with reformation of CFA & profunda run.CTO of SFA,Pop A & PTA with reformation of ATA A/A..Planned:Rt-Lt FCB with fem-ATA bypass.Right to left FCB done with 7 mm e-ptfe graft under spinal anesthesia. Good pulsatile flow observed in left CFA & profunda.ATA exposed showed good downward flow after thrombectomy.ATA closed without bypass.After 3 days gangrenous toes amputated & closed. Ankle gangrenous part debrided. Patient doing well on several follow-up.

case 2
A 60 yr old gentleman chronic smoker presented with Rt leg claudication & gangrenous 2 toes.He underwent left to right fem-fem crossover bypass & rt fem-pop bypass using eptfe interring grafts.He was doing good in follow up but didn't quit smoking & eventually landed with occluded grafts after 2 years. Now managing with best medical therapy.
The FCB in patients with disabling claudication caused by unilateral iliac artery disease is still a valuable alternative to aortofemoral grafting in those who are not suitable for endovascular repair or major abdominal surgery, or have poor general or local conditions, presenting in recent series with good long-term patency and low complication rates.