An alternative method of transperitoneal graft introduction in aortobifemoral bypass surgery

Aorto-iliac occlusive (AIO) disease is one of the most common forms of arteriosclerosis obliterans (ASO).1 The gold-standard treatment of this disease is aortofemoral bypass surgery, according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) study.1-3Surgeons have performed this procedure for many years with good long-term results. Vascular damage, bleeding, intestinal damage, ileus, myocardial infarction and renal failure are considered short-term complications. Secondary aorto-enteric fistula, sexual dysfunction, infection, graft thrombosis and anastomotic pseudo-aneurysm may be considered long-term complications.4-6 Among these complications, vascular damage, intestinal damage and aorto-enteric fistulae usually occur while introducing the graft into the femoral area.If the tunneller, which was specifically designed for aortofemoral bypass procedures, is not available for some reason, long, blunt-tipped tunnelling forceps are used instead. A nylon tape is taken through the tunnel with the tunnelling forceps after the tunnel is created. Aortic anastomosis is performed after heparinisation.Connecting the distal ends of the graft to the femoral area is performed in the conventional method by introducing the forceps into the tunnel a second time and pulling the graft through the tunnel. In an alternative method, the nylon tape that is taken through the tunnel with the tunnelling forceps is tied to the graft, which is pulled through into the femoral area. By not introducing the forceps a second time into the tunnel, complications caused by the forceps may be reduced. The results of both methods were analysed for postoperative bleeding, vascular injury and intestinal complications.