A 55-year-old man presents with bilateral thigh claudication and impotence. Femoral pulses are absent bilaterally. ABI is 0.35 on both sides. Imaging confirms complete occlusion of the aortoiliac segment (Leriche syndrome). The preferred bypass procedure for long-segment aortoiliac occlusion in a fit patient is:
- A Femoral-femoral crossover bypass
- B Axillo-bifemoral bypass
- C Percutaneous transluminal angioplasty with stenting (aortoiliac PTA)
- D Aorto-bifemoral bypass (ABF) using Dacron prosthesis ✓
Explanation
Aorto-bifemoral bypass using a Dacron prosthetic graft is the gold-standard treatment for extensive aortoiliac occlusive disease (TASC II type D lesions) in fit patients, with 5-year patency rates >85% and 10-year patency >75%. It restores antegrade aortic flow and treats both iliac systems simultaneously. Axillo-bifemoral bypass is reserved for high-risk patients unsuitable for aortic surgery. Femoral-femoral crossover requires at least one patent iliac artery. Endovascular PTA/stenting is preferred for focal (TASC A/B) aortoiliac lesions but has inferior long-term outcomes for total occlusion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.