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Extra-Anatomic Bypass

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PanVascular Medicine

Abstract

The so-called extra-anatomic bypasses are surgical arterial or venous bypass procedures that circumvent the “normal” anatomic pathways. While such procedures can be performed in any vascular bed, the term most frequently is used to describe those bypasses that reroute blood to the lower extremities, avoiding intracavitary procedures. Initially promulgated as alternative revascularization methods in the treatment of peripheral arterial occlusive disease and as techniques for bringing blood back to the lower extremities in “clean fields” in the face of prosthetic infections, their role has expanded in recent years. The advent of complex endovascular technologies to treat a myriad of aortic pathologies has resurged these bypasses as adjunctive procedures in aortic endografting. In this chapter, we discuss the indications and techniques of the more commonly used extra-anatomic bypass and also touch on more complex indications and uses in the endovascular era. Much of our discussion will focus on the more common lower extremity bypasses – femorofemoral bypass and axillofemoral bypass. We will also discuss aortic arch vessel cervical extra-anatomic bypasses. Indications, techniques, and unique complications will all be covered.

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References

  • AbuRahma AF, Robinson PA, Jennings TG (2000) Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: a 20-year experience. J Vasc Surg 32:411–418

    Article  PubMed  CAS  Google Scholar 

  • Aburahma AF, Robinson PA, Cook CC et al (2001) Selecting patients for combined femorofemoral bypass grafting and iliac balloon angioplasty and stenting for bilateral iliac disease. J Vasc Surg 33(2 Suppl):S93–S99

    Article  PubMed  CAS  Google Scholar 

  • Agee JM, Kron IL, Flanagan T et al (1991) The risk of axillofemoral bypass grafting for acute vascular occlusion. J Vasc Surg 14(2):190–194

    Article  PubMed  CAS  Google Scholar 

  • Alexander RH, Selby JH (1980) Axillofemoral bypass grafts using polytetrafluoroethylene. South Med J 73(10):1325–1329, 1332

    Article  PubMed  CAS  Google Scholar 

  • Al-Wahbi A (2010) Axillofemoral bypass with local anesthesia: a way forward to enable limb salvage in high-risk patients. Local Reg Anesthesia 3:129–132

    Article  Google Scholar 

  • Angle N, Dorafshar AH, Farooq MM et al (2002) The evolution of the axillofemoral bypass over two decades. Ann Vasc Surg 16:742–745

    Article  PubMed  Google Scholar 

  • Ascer E, Veith FJ, Gupta SK et al (1985) Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery 97:169–174

    PubMed  CAS  Google Scholar 

  • Bacourt F, Koskas F (1992) Axillobifemoral bypass and aortic exclusion for vascular septic lesions: a multicenter retrospective study of 98 cases. French University Association for Research in Surgery. Ann Vasc Surg 6(2):119–126

    Article  PubMed  CAS  Google Scholar 

  • Bandyk DF, Thiele BL, Radke HM (1981) Upper-extremity complications of axillofemoral grafts. Arch Surg 116:393–395

    Article  PubMed  CAS  Google Scholar 

  • Berguer R, Gonzalez JA (1994) Revascularization by the retropharyngeal route for extensive disease of the extracranial arteries. J Vasc Surg 19:217–225

    Article  PubMed  CAS  Google Scholar 

  • Berguer R, Morasch M, Kline R (1999) Cervical reconstruction of the supra-aortic trunks: a 16-year experience. J Vasc Surg 29:239–248

    Article  PubMed  CAS  Google Scholar 

  • Blaisdell FW (1985) Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts. J Vasc Surg 2(6):925–926

    Article  PubMed  CAS  Google Scholar 

  • Blaisdell FW (1988) Extraanatomical bypass procedures. World J Surg 12(6):798–804

    Article  PubMed  CAS  Google Scholar 

  • Blaisdell FW (2010) Development of femoro-femoral and axillo-femoral bypass procedure. J Vasc Surg 53:540–544

    Article  Google Scholar 

  • Blaisdell FW, Hall AD (1963) Axillary-femoral artery bypass for lower extremity ischemia. Surgery 54:563–568

    PubMed  CAS  Google Scholar 

  • Brener BJ, Brief DK, Alpert J et al (1993) Femorofemoral bypass: a twenty-five year experience. In: Yao JST, Pearce WH (eds) Long-term results in vascular surgery. Appleton & Lange, East Norwalk, pp 385–393

    Google Scholar 

  • Brief DK, Brener BJ, Alpert J et al (1975) Crossover femorofemoral grafts followed up five years or more. An analysis. Arch Surg 110(11):1294–1299

    Article  PubMed  CAS  Google Scholar 

  • Burrell MJ, Wheeler JR, Gregory RT et al (1982) Axillofemoral bypass: a ten year review. Ann Surg 195:796–799

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Buth J, Harris PL, Hobo R et al (2007) Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg 46:1103–1110

    Article  PubMed  Google Scholar 

  • Chang JB, Stein TA, Liu JP et al (1997) Long-term results with axillo-axillary bypass grafts for symptomatic subclavian artery insufficiency. J Vasc Surg 25:173–178

    Article  PubMed  CAS  Google Scholar 

  • Chuter TA, Faruqi RM, Reilly LM et al (1999) Aortomonoiliac endovascular grafting combined with femorofemoral bypass: an acceptable compromise or a preferred solution? Semin Vasc Surg 12(3):176–181

    PubMed  CAS  Google Scholar 

  • Cina C, Safar HA, Lagana A et al (2002) Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg 35:422–429

    Article  PubMed  Google Scholar 

  • Criado E (1997) Descending thoracic aorta to femoral artery bypass: surgical technique. Ann Vasc Surg 11:206–215

    Article  PubMed  CAS  Google Scholar 

  • Criado E, Keagy BA (1994) Use of the descending thoracic aorta as an inflow source in aortoiliac reconstruction: indications and long-term results. Ann Vasc Surg 8:38–47

    Article  PubMed  CAS  Google Scholar 

  • Daar AS, Finch RA (1978) Graft avulsion: an unreported complication of axillofemoral bypass grafts. Br J Surg 65:442–447

    Article  PubMed  CAS  Google Scholar 

  • Dick LS, Brief DK, Alpert J et al (1980) A 12-year experience with femorofemoral crossover grafts. Arch Surg 115(11):1359–1365

    Article  PubMed  CAS  Google Scholar 

  • Donahoe PK, Froio RA, Nabseth DC (1967) Obturator bypass graft in radical excision of inguinal neoplasm. Ann Surg 166(1):147–149

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Ehrenfeld WK, Harris JD, Wylie EJ (1968) Vascular “steal” phenomenon. An experimental study. Am J Surg 116:192–197

    Article  PubMed  CAS  Google Scholar 

  • El-Massry S, Saad E, Sauvage LR et al (1993) Axillofemoral bypass with externally supported, knitted Dacron grafts: a follow-up through twelve years. J Vasc Surg 17:107–115

    Article  PubMed  CAS  Google Scholar 

  • Fatima J, Duncan AA, deGrandis E et al (2013) Treatment strategies and outcomes in patients with infected aortic endografts. J Vasc Surg 58:371–379

    Article  PubMed  Google Scholar 

  • Flanigan DP, Pratt DG, Goodreau JJ et al (1978) Hemodynamic and angiographic guidelines in selection of patients for femorofemoral bypass. Arch Surg 113(11):1257–1262

    Article  PubMed  CAS  Google Scholar 

  • Frazier OH, Oalmann MC, Strong JP et al (1987) Clinical applications of the supraceliac aorta: anatomic and pathologic observations. J Thorac Cardiovasc Surg 93:631–633

    PubMed  CAS  Google Scholar 

  • Freeman NE, Leeds FH (1952) Operations on large arteries; application of recent advances. Calif Med 77(4):229–233

    PubMed  CAS  PubMed Central  Google Scholar 

  • Grochow RM, Raffetto JD (2008) Chronic traumatic pseudoaneurysm of polytetrafluoroethylene axillofemoral bypass graft in a quadriplegic patient. Ann Vasc Surg 22:688–691

    Article  PubMed  Google Scholar 

  • Harrington ME, Harrington EB, Haimov M et al (1992) Iliofemoral versus femorofemoral bypass: the case for an individualized approach. J Vasc Surg 16(6):841–852, discussion 852–854

    Article  PubMed  CAS  Google Scholar 

  • Hepp W, Jonge K, Pallua N (1988) Late results following extra-anatomic bypass procedures for chronic aortoiliac occlusive disease. J Cardiovasc Surg (Torino) 29(2):181–185

    CAS  Google Scholar 

  • Hinchliffe RJ, Alric P, Wenham P et al (2003) Durability of femorofemoral bypass grafting after aortouniiliac endovascular aneurysm repair. J Vasc Surg 38:498–503

    Article  PubMed  Google Scholar 

  • Huded CP, Goodney PP, Powell RJ et al (2012) The impact of adjunctive iliac stenting on femoral-femoral bypass in contemporary practice. J Vasc Surg 55(3):739–745. doi:10.1016/j.jvs.2011.10.036, discussion 744–745

    Article  PubMed  PubMed Central  Google Scholar 

  • Ishimaru S (2004) Endografting of the aortic arch. J Endovasc Ther 11:II62–II71

    Article  PubMed  Google Scholar 

  • Johnson WC, Lee KK (1999) Comparative evaluation of externally supported Dacron and polytetrafluoroethylene prosthetic bypasses for femorofemoral and axillofemoral arterial reconstructions. Veterans Affairs Cooperative Study #141. J Vasc Surg 30(6):1077–1083

    Article  PubMed  CAS  Google Scholar 

  • Kallakuri S, Ascher E, Hingorani A et al (2003) Endovascular management of axillofemoral bypass graft stump syndrome. J Vasc Surg 38:833–835

    Article  PubMed  Google Scholar 

  • Kalman PG, Hosang M, Cina C et al (1987) Current indications for axillounifemoral and axillobifemoral bypass grafts. J Vasc Surg 5:828–832

    Article  PubMed  CAS  Google Scholar 

  • Kempczinski R, Penn I (1978) Upper extremity complications of axillofemoral grafts. Am J Surg 136:209–211

    Article  PubMed  CAS  Google Scholar 

  • Khalil IM, Hoballah JJ (1991) Late upper extremity embolic complications of occluded axillofemoral grafts. Ann Vasc Surg 5:375–380

    Article  PubMed  CAS  Google Scholar 

  • Knepper J, Criado E (2013) Surgical treatment of Kommerell’s diverticulum and other saccular arch aneurysms. J Vasc Surg 57:951–954

    Article  PubMed  Google Scholar 

  • Law MM, Colburn MD, Moore WS et al (1995) Carotid-subclavian bypass for brachiocephalic occlusive disease. Choice of conduit and long-term follow-up. J Vasc Surg 26:1565–1571

    CAS  Google Scholar 

  • Leon LR, Mills JL, Psalms SB et al (2007) A novel hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stent grafting and femorofemoral bypass grafting. J Vasc Surg 45(6):1244–1248

    Article  PubMed  Google Scholar 

  • LoGerfo FW, Johnson WC, Corson JD et al (1977) A comparison of the late patency rates of axillobilateral femoral and axillounilateral femoral grafts. Surgery 81:33–40

    PubMed  CAS  Google Scholar 

  • Louw JH (1963) Splenic-to-femoral and axillary-to-femoral bypass grafts in diffuse atherosclerotic occlusive disease. Lancet Orig 281(7296):1401–1402

    Article  Google Scholar 

  • Manart FD, Kempczinski RF (1980) The carotid-carotid bypass graft. Arch Surg 115:669–671

    Article  PubMed  CAS  Google Scholar 

  • Matsumura JS, Rizvi AZ (2010) Left subclavian artery revascularization: society for vascular surgery practice guidelines. J Vasc Surg 52:65S–70S

    Article  PubMed  Google Scholar 

  • McCarthy WJ, Mesh CL, McMillan WD et al (1993) Descending thoracic aorta-to-femoral artery bypass: ten years’ experience with a durable procedure. J Vasc Surg 17:336–347

    Article  PubMed  CAS  Google Scholar 

  • McLafferty RB, Taylor LM, Moneta GL et al (1995) Upper extremity thromboembolism caused by occlusion of axillofemoral grafts. Am J Surg 169:492–495

    Article  PubMed  CAS  Google Scholar 

  • Melissano G, Civilini E, Bertoglio L et al (2007) Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg 33:561–566

    Article  PubMed  CAS  Google Scholar 

  • Mingoli A, Sapienza P, Feldhaus RJ et al (2001) Femorofemoral bypass grafts: factors influencing long-term patency rate and outcome. Surgery 129(4):451–458

    Article  PubMed  CAS  Google Scholar 

  • Mohan CR, Sharp WJ, Hoballah JJ et al (1995) A comparative evaluation of externally supported polytetrafluoroethylene axillobifemoral and axillounifemoral bypass grafts. J Vasc Surg 21:801–809

    Article  PubMed  CAS  Google Scholar 

  • Mozersky DJ, Summer DS, Barnes RW et al (1973) Subclavian revascularization by means of a subcutaneous axillary-axillary graft. Arch Surg 106:20–23

    Article  PubMed  CAS  Google Scholar 

  • Murphy EH, Stanley GA, Ilves M et al (2012) Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg 26:55–66

    Article  PubMed  Google Scholar 

  • Nevelsteen A, Mees U, Deleersnijder J et al (1987) Obturator bypass: a sixteen year experience with 55 cases. Ann Vasc Surg 1:558–563

    Article  PubMed  CAS  Google Scholar 

  • Nicholson ML, Beard JD, Horrocks M (1988) Intra-operative inflow resistance measurement: a predictor of steal syndromes following femoro-femoral bypass grafting. Br J Surg 75(11):1064–1066

    Article  PubMed  CAS  Google Scholar 

  • Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45S:S5–S67

    Article  Google Scholar 

  • Oderich GS, Bower TC, Cherry KJ et al (2006) Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center. J Vasc Surg 43:1166–1174

    Article  PubMed  Google Scholar 

  • Onoe M, Watarida S, Sugita T et al (1994) Disruption of the expanded polytetrafluoroethylene (EPTFE) graft of axillofemoral by-pass. J Cardiovasc Surg (Torino) 35:165–168

    CAS  Google Scholar 

  • Ozvath KJ, Roddy SP, Darling RC et al (2003) Carotid-carotid crossover bypass: is it a durable procedure? J Vasc Surg 37:582–585

    Article  Google Scholar 

  • Passman MA, Taylor LM, Moneta GL et al (1996) Comparison of axillofemoral and aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg 23(2):263–269, discussion 269–271

    Article  PubMed  CAS  Google Scholar 

  • Passman MA, Farber MA, Criado E et al (1999) Descending thoracic aorta to iliofemoral artery bypass grafting: a role for primary revascularization for aortoiliac occlusive disease? J Vasc Surg 29:249–258

    Article  PubMed  CAS  Google Scholar 

  • Perler BA, Williams GM (1990) Carotid-subclavian bypass–a decade of experience. J Vasc Surg 12:716–722

    Article  PubMed  CAS  Google Scholar 

  • Perler BA, Williams GM (1996) Does donor iliac artery percutaneous transluminal angioplasty or stent placement influence the results of femorofemoral bypass? Analysis of 70 consecutive cases with long-term follow-up. J Vasc Surg 24(3):363–369, discussion 369–370

    Article  PubMed  CAS  Google Scholar 

  • Pfitzner J (1976) Poiseuille and his law. Anaesthesia 31(2):273–275

    Article  PubMed  CAS  Google Scholar 

  • Porter JM, Eidemiller LR, Dotter CT et al (1973) Combined arterial dilatation and femorofemoral bypass for limb salvage. Surg Gynecol Obstet 137(3):409–412

    PubMed  CAS  Google Scholar 

  • Ricco JB, Probst H (2008) Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease. J Vasc Surg 47(1):45–53, discussion 53–54

    Article  PubMed  Google Scholar 

  • Riesenman PJ, Farber MA (2010) Management of a thoracic endograft infection through an ascending to descending extra-anatomic aortic bypass and endograft explantation. J Vasc Surg 51:207–209

    Article  PubMed  Google Scholar 

  • Ruggiero NJ, Jaff MR (2011) The current management of aortic, common iliac, and external iliac artery disease: basic data underlying clinical decision making. Ann Vasc Surg 25:990–1003

    Article  PubMed  Google Scholar 

  • Rutherford RB, Patt A, Pearce WH (1987) Extra-anatomic bypass: a closer view. J Vasc Surg 6(5):437–446

    Article  PubMed  CAS  Google Scholar 

  • Salam TA, Lumsden AB (1994) Subclavian artery revascularization: a decade of experience with extrathoracic bypass procedures. J Surg Res 56:387–392

    Article  PubMed  CAS  Google Scholar 

  • Sautner T, Niederle B, Herbst F et al (1994) The value of obturator canal bypass. A review. Arch Surg 129(7):718–722

    Article  PubMed  CAS  Google Scholar 

  • Savrin RA, Record GT, McDowell DE (1986) Axillofemoral bypass. Expectations and results. Arch Surg 121(9):1016–1020

    Article  PubMed  CAS  Google Scholar 

  • Scali ST, Chang CK, Pape SG et al (2013) Subclavian revascularization in the age of thoracic endovascular aortic repair and comparison of outcomes in patients with occlusive disease. J Vasc Surg 58:901–909

    Article  PubMed  PubMed Central  Google Scholar 

  • Schneider JR, Golan JF (1994) The role of extraanatomic bypass in the management of bilateral aortoiliac occlusive disease. Semin Vasc Surg 7(1):35–44

    PubMed  CAS  Google Scholar 

  • Schneider JR, Besso SR, Walsh DB et al (1992) Femorofemoral versus aortobifemoral bypass: outcome and hemodynamic results. J Vasc Surg 15:952–963

    Article  PubMed  CAS  Google Scholar 

  • Seeger JM, Pretus HA, Welborn MB et al (2000) Long-term outcome after treatment of aortic graft infection with staged extra-anatomic bypass grafting and aortic graft removal. J Vasc Surg 32(3):451–459, discussion 460–461

    Article  PubMed  CAS  Google Scholar 

  • Shaw RS, Baue AE (1963) Management of sepsis complicating arterial reconstructive surgery. Surgery 53:75–86

    PubMed  CAS  Google Scholar 

  • Shibutani S, Obara H, Kakefuda T et al (2012) Nonanastomotic pseudoaneurysm with complete disruption of an expanded polytetrafluoroethylene axillofemoral bypass graft. Ann Vasc Surg 26:422e9–422e12

    Article  Google Scholar 

  • Shin CS, Chaudhry AG (1979) The hemodynamics of extra-anatomic bypass grafts. Surg Gynecol Obstet 148(4):567–570

    PubMed  CAS  Google Scholar 

  • Stevenson JK, Sauvage LR, Harkins HN (1961) A bypass homograft from thoracic aorta to femoral arteries for occlusive vascular disease: case report. Am Surg 27:632–637

    Google Scholar 

  • Taylor LM, Park TC, Edwards JM et al (1994) Acute disruption of polytetrafluoroethylene grafts adjacent to axillary anastomoses: a complication of axillofemoral grafting. J Vasc Surg 20:520–528

    Article  PubMed  Google Scholar 

  • Trimble IR, Stonesifer GL, Wilgis EF et al (1972) Criteria for femoro-femoral bypass from clinical and hemodynamic studies. Ann Surg 175(6):985–993

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Vetto RM (1962) The treatment of unilateral iliac artery obstruction with a transabdominal, subcutaneous, femorofemoral graft. Surgery 52:343–345

    PubMed  CAS  Google Scholar 

  • Vitti MJ, Thompson BW, Read RC et al (1994) Carotid-subclavian bypass: a twenty-two-year experience. J Vasc Surg 20:411–417

    Article  PubMed  CAS  Google Scholar 

  • White GH, Donayre CE, Williams SE et al (1990) Exertional disruption of axillofemoral graft anastomosis. ‘The axillary pullout syndrome’. Arch Surg 125:625–627

    Article  PubMed  CAS  Google Scholar 

  • Ziomek S, Quinones-Baldrich WJ, Busuttil RW et al (1986) The superiority of synthetic arterial grafts over autologous veins in carotid-subclavian bypass. J Vasc Surg 3:140–145

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Mills-Peninsula Division, Palo Alto Medical Foundation, Burlingame, CA, USA

    Ed Aboian M.D. (Staff Surgeon)

  2. Division of Vascular and Endovascular Surgery, Maimonides Medical Center, 947 49th Street, 4802 Tenth Avenue, 11219, Brooklyn, NY, USA

    Atul S. Rao M.D. (Attending Vascular Surgeon, Associate Program Director, Vascular Surgery Fellowship)

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  1. Ed Aboian M.D.
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  2. Atul S. Rao M.D.
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Correspondence to Atul S. Rao M.D. .

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  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Aboian, E., Rao, A.S. (2014). Extra-Anatomic Bypass. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_137-2

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