RT Book, Section A1 Ellison, E. Christopher A1 Zollinger, Robert M. SR Print(0) ID 1127274931 T1 FEMOROFEMORAL BYPASS T2 Zollinger's Atlas of Surgical Operations, 10e YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179755-9 LK accesssurgery.mhmedical.com/content.aspx?aid=1127274931 RD 2024/03/28 AB Only patients with severe and debilitating occlusive disease of a unilateral aortoiliac segment should be considered for femorofemoral bypass. Today, endovascular angioplasty and stenting have reduced the indications for both aortofemoral bypass and femorofemoral bypasses, but there remains the occasional patient in whom bypass is the preferred treatment. Not all patients with a long-standing unilateral aortoiliac occlusion can be recannulated by endovascular techniques. In those patients where recannulation cannot be accomplished, femorofemoral bypass may be the preferred operative option. The contralateral, or donor aortoiliac segment should be free of occlusive disease. In the case where there is occlusive disease on the donor side, balloon angioplasty and stenting may need to be performed first to assure adequate inflow. Unilateral claudication is the leading indication for femorofemoral bypass, but occasionally rest pain, ulceration and gangrene may be the indication especially in the presence of significant comorbidities in the elderly. In younger patients with unilateral claudication, femorofemoral bypass may be preferred over the more durable aortofemoral bypass to eliminate the risk of retrograde ejaculation in those patients desiring children. While the younger patients are generally healthier and the operation is less invasive than aortofemoral bypass, the long-term patency is reduced and these factors need to be considered in the decision making. Elderly patients may still have generalized arteriosclerosis, including coronary artery disease and hypertension, and careful selection remains important.