Clinical outcomes of obturator canal bypass

Abstract

Objective: Infected aortofemoral grafts pose a formidable challenge with a significant risk of limb loss and high mortality. Despite successful reports of obturator canal bypass (OCB) for infected aortofemoral graft and complicated groins, the technique has not gained widespread use. We reviewed our experience with OCB and performed a systematic review of the literature.

Methods: A retrospective review of patients who underwent OCB in our institution between 1995 and 2013 was conducted. Demographics of the patients, comorbidities, previous interventions, and postoperative and longer term related events were recorded. Outcomes were primary and secondary patency, limb salvage, and survival rates. For the literature review, all published series in the English language were identified through a PubMed database query.

Results: Fifteen patients underwent 18 OCBs during the study period. Mean age was 59.6 ± 12 years, and 11 were men. Indications for surgery were chronic infection in 10 patients and acute bleeding in 5. Polytetrafluoroethylene was used in all cases. Mean clinical follow-up was 57.7 ± 42.3 months (range, 7.4-181). The 30-day complications included three (16.7%) superficial wound infections without any cardiac events, stroke, or death. Midterm outcomes included five late deaths and one myocardial infarction. Regarding major adverse limb events, three patients underwent above-knee amputation. Another procedure was required in 11 of the 18 limbs (61%) at a mean duration of 42 months for reoperation and 35 months for reintervention. One OCB (6%) became infected, requiring removal at 42 months. Primary, primary assisted, and secondary patency was 65%, 71%, and 88% at 24 months, respectively. Overall survival and limb salvage was 83% and 81% at 36 months, respectively.

Conclusions: The OCB can be performed safely with minimal early morbidity and mortality in well-selected patients with infections limited to one femoral anastomosis site. Limb salvage and overall mortality in this series are excellent and in agreement with the reported literature on OCB. Long-term follow-up is recommended because of a significant reoperation and reintervention rate.