Crossover iliofemoral bypass graft through tension-free abdominal wall-repair mesh

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COD: 10_2643_AOP Categorie: ,

Mircea Muresan, Ovidiu Jimborean, Gabriela Jimborean, Radu Neagoe, Serban Bancu, Simona Muresan, Cristian Borz

Ann Ital Chir, 2017 88, 5: 433-437
Epub Ahead of Print 8 June 2017

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INTRODUCTION: In vascular surgery the crossover iliofemoral bypass grafting is a well-known surgical technique. In general
surgery the repair of an abdominal defect using a Polypropylene mesh is also a standard procedure. A particular
technique is defined by the performance of these 2 separate procedures inside a single operation in which the crossover
arterial graft is directed from the retroperitoneal space toward the contra-lateral femoral bifurcation through a Polypropylene
mesh which closes the musculoaponeurotic layers of the abdominal wall. We present our experience with the use of this
particular surgical technique in patients with critical limb ischemia and with indication for extra-anatomic crossover
bypass (high-risk patients with contra-indication for the transperitoneal approach, extensive calcified aortic or iliac wall
which contraindicated the direct arterial reconstruction or secondary arterial reconstruction after the occlusion of an aorto-
femoral graft).
METHODS: In principle, the hernioplasty was performed by using the Lichtenstein tension-free hernia repair technique,
followed by the crossover iliofemoral bypass. The main feature of this technique is to pass the vascular graft from the
retroperitoneal space above the mesh through a calibrated hole in the mesh
RESULTS: The 7 patients with inguinal hernia and l limb-threatening ischemia had favorable evolution, without hernia
recurrence, limb-threatening ischemia or any graft complication at 3 years.
DISCUSSION: Using this particular surgical technique we treated 2 surgical diseases using a single intervention for highrisk
patients who had both inguinal hernia and contra-lateral critical limb ischemia. Being encouraged by the initial
satisfactory results, we extended this technique even for the patients with indication of crossover iliofemoral bypass but
without inguinal hernia.
CONCLUSIONS: The particular surgical technique of the crossover bypass in which the vascular graft crosses a tension-free
Polypropylene mesh from the retroperitoneal space toward the Retzius space represents an efficient and short procedure
which treats simultaneously 2 different surgical diseases (inguinal hernia and contra-lateral critical limb ischemia) in
high-risk patients. The results were satisfactory: we had no hernia recurrence and the limb-threatening ischemia was successfully
treated. The preferred vascular graft for this particular technique is the reversed autogenous vein because its resistance
to infections and the vein long-term patency is better than of a vascular prosthesis. When a prosthetic graft is
required, we prefer to use the classic technique in which the crossover graft is placed in an under-aponeurosis site, in
order to diminish the prosthesis infection risk.

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