Extra-anatomic Revascularization

Abstract

In the presence of severe unilateral iliac occlusive disease that is not amenable to endovascular therapy, revascularization can be accomplished via an extraanatomic route by performing a crossover femorofemoral bypass originating from the contralateral limb. The donor limb should not suffer untoward effects from the extra-anatomic revascularization even in the presence of infrainguinal disease unless proximal hemodynamic stenoses were missed or left untreated. If the donor inflow is marginal due to the presence of proximal disease in its iliac system, endovascular therapy is used to correct the proximal pathology. This can be performed a few days prior to the extra-anatomic revascularization, typically when the pathology is identified on preoperative angiography. Alternatively, the endovascular therapy can be performed simultaneously during the construction of the femoro-femoral bypass especially if magnetic resonance angiography or CT angiography was used for preoperative evaluation.