Extra anatomic revascularization

Aortoiliac replacement by extraanatomical bypass is defined as distal revascularization of the limbs distally to an infection or obstructive disease of the aorta or iliac arteries; its course does not follow the original anatomical pathway. Direct anatomical reconstruction for aortoiliac occlusive disease provides superior long-term graft patency. It is preferred for the treatment of Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions over endovascular approaches and extraanatomical bypass in patients with disabling intermittent claudication or severe lower extremity ischemia. However, extraanatomical revascularization should be considered as an alternative to direct anatomical revascularization when cardiovascular or pulmonary risk factors preclude abdominal aortic surgery, due to the low long-term primary patency rate of 49.4-72%.1 In fact, the indication for extraanatomical bypass is often out of necessity. According to the latest European Society of Vascular Surgery (ESVS) guidelines,2 femorofemoral crossover bypass may be considered as an alternative for aortoiliac lesions in patients who are not suitable for iliac endovascular or anatomical surgical revascularization.