Trans-Iliac Bypass Grafting for Vascular Groin Complications

Abstract

WHAT THIS PAPER ADDS This represents the largest series of trans-iliac bypass grafting to date, with a review of the published data. An evaluation of this rare extra-anatomic bypass technique was performed. Patency as well as limb salvage and patient survival were good and may be comparable to those reported for autologous in situ repair and obturator canal bypass grafting. Objectives: Groin complications following vascular reconstruction, extensive trauma, or severe radiation induced scarring may complicate future revascularisation procedures of the lower limb. Although several techniques have been described, only few cases of trans-iliac bypass grafting have been published. The aim of this study was to perform a review of the literature on trans-ilac bypass grafting and add the authors' experience. Methods: A single centre retrospective data analysis and a literature review of all trans-iliac bypass procedures was performed. Data on indication, patency, limb salvage, and survival were collected. Study endpoints were patency, limb salvage, and patient survival. Results: Eight trans-iliac wing bypass grafting procedures were performed in our institution between 2003 and 2018, which represents the largest single centre series. Twenty-three procedures were reported in the literature between 1989 and 2018. Prior to the bypass procedure in the eight patients, six had local infection and two irradiation of the groin. The indication for operation was ischaemia in six cases, bleeding in one case, and infection in another case. The external iliac artery was most often used for the proximal (6 cases) and the superficial femoral artery for distal anastomosis (6 cases). Great saphenous vein was the most commonly used graft material (6 cases). The median follow up was five years with three bypass occlusions after 1, 2, and 8 months, followed by two successful thrombectomy procedures. There were no major amputations and only one death after five months, which was not procedure related. Conclusions: Trans-iliac bypass grafting is a viable alternative extra-anatomic bypass technique in patients with vascular groin complications. Patency as well as limb salvage and survival are good and may be comparable to those reported for autologous in situ repair and obturator canal bypass grafting.

Re: “Trans-iliac Bypass Grafting for Vascular Groin Complications”

“…We want to thank Barillà et al for commenting on our publication and sharing their experience with a challenging vascular groin complication. 1 Although the primary endovascular approach in this situation was definitely effective, the use of extra-anatomic bypass techniques remains an important part of managing these complex cases. The reported subcutaneous tunnelling of the bypass graft is one of many options.…”

Right axillopopliteal artery bypass using a combined transiliac and lateral popliteal approach for groin infection and lymph fistula

“… 1 , 2 , 3 In this case, we successfully managed the wound infection in the groin after axillofemoral artery bypass grafting, using a combination of transiliac bypass and lateral popliteal approach. 4 , 5 …”

Aortic–tibial transiliac wing extra-anatomic bypass with distal fistula for treatment of an infected deep femoral pseudoaneurysm

“…Transiliac wing bypass has been reported to be a viable extra-anatomic alternative technique for patients presenting with a history of groin infection or irradiation. 1 Of the 32 reported cases, only two patients had undergone transiliac aortic–tibial or iliotibial bypass. 2 , 3 We report the case of a 72-year-old man with a complex history of multiple lower limb revascularizations, who had been admitted for a deep femoral infected anastomotic pseudoaneurysm ( A ) and left chronic limb threatening ischemia.…”