Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair?

Purpose: The need for cross-femoral bypass grafting (CFBG) is considered by some to be a major disadvantage of endovascular aneurysm repair (EVAR) with the aortomonoiliac technique. To determine the durability of CFBG in this setting, we examined data from 148 consecutive high-risk patients in a clinical trial of EVAR with a custom-made aortomonoiliac endovascular stent graft. Methods: All data were collected prospectively. After hospital discharge, patients were evaluated at 1, 3, and 6 months and annually thereafter. All CFBG was constructed of expandable polytetrafluoroethylene. Results: During follow-up averaging 23.6 ± 16.2 months, nine CFBG complications developed in 8 patients (5.4%), including disruption (n = 2), infection (n = 3), thrombosis (n = 2), and pseudoaneurysm (n = 3). Four patients with CFBG complications died, of consequences of infection (n = 2), intracranial hemorrhage during attempted CFBG thrombolysis (n = 1), and intracranial hemorrhage during anticoagulation (n = 1). There were no amputations. At life table analysis, freedom from CFBG complication was 96.3% ± 1.6% at 12 months, 94.1% ± 2.2% at 24, 36, and 48 months, and 86.2% ± 7.8% at 60 months. Overall survival for this high-risk patient group was 83.4% ± 3.1% at 12 months, 70.4% ± 4.1% at 24 months, 56.5% ± 5.3% at 36 months, and 44.8% ± 6.4% at 48 months. Conclusion: CFBG is durable, with a low rate of complications in patients undergoing aortomonoiliac EVAR. Need for CFBG should not discourage use of aortomonoiliac devices in patients with anatomy unfavorable for other EVAR approaches.