Revascularization of the Lower Extremity: A Non-invasive Hemodynamic Comparison of Aorto-Femoral and Femoral-Femoral Bypass

Abstract

Nine patients who underwent bilateral aorto-femoral bypass and seven patients who underwent femoral-femoral bypass were evaluated to determine the increase in ankle/ arm index (a/a index) in symptomatic extremities. All patients underwent pre- and postoperative noninvasive evaluation. There were 13 symptomatic extremities in the 9 patients undergoing aorto-femoral bypass. The mean pre-operative a/a index in the aorto-femoral group was 0.50±0.15. The mean post-operative value was 0.75±0.16 (p<0.0001). The mean pre-operative value in the femoral-femoral group was 0.39±0.30 and the mean post-operative value 0.74±0.24 (p<0.02). The increase in the postoperative a/a index was the same with femoral-femoral bypass as with aorto-femoral bypass. A decision as to whether aorto-femoral or femoral-femoral bypass should be performed should be determined by considerations other than the expected immediate hemodynamic effect.

Extra-anatomic bypass has become an alternative to standard aorto-femoral bypass for lower extremity revascularization in selected patients. 1,2 There have been numerous reports which have demonstrated the clinical effectiveness of both of these procedures in relieving ischemia.³ The hemodynamic effects of aorto-femoral bypass have been extensively studied non-invasively by comparing pre- and post-operative values of the ankle/arm index (a/a index).⁴ We have retrospectively studied the results of both aorto-femoral and femoral-femoral bypass to determine the relative effect of each in increasing the a/a index and to determine whether aorto-femoral bypass raises the a/a index more than does the femoral-femoral bypass.