Femorofemoral Bypass

Femorofemoral bypass (FFB) has become an important tool for vascular surgeons, but despite more than 40 years experience with FFB, controversy persists regarding its appropriate use. FFB is much less invasive than aortofemoral bypass and many authors have suggested extended use of FFB in patients with predominantly unilateral iliac artery occlusive disease. However, others have concluded FFB does not perform as well as aortofemoral bypass when assessed by hemodynamics or long term patency. This issue is further complicated by the fact that many younger lower risk patients who would previously have undergone aortofemoral bypass are now treated using endovascular techniques, leaving a pool of generally higher risk patients who cannot be treated with endovascular techniques alone and may not be appropriate candidates for aortofemoral bypass. Aortoiliac balloon angioplasty may make an otherwise unsatisfactory iliac artery a more appropriate donor for FFB, but it is not clear that the results of FFB in these patients are comparable to those in patients whose donor iliac arteries do not require endovascular treatment. Finally, endovascular treatment of aortoiliac aneurysmal disease may be accomplished in part using FFB. This chapter will attempt to examine the historical role of FFB and the evolution of FFB in view of recent trends in vascular surgery.