Ann Vasc Surg. 2021 Apr 10:S0890-5096(21)00202-8. doi: 10.1016/j.avsg.2021.02.011. Online ahead of print.
OBJECTIVE: Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts.
METHODS: A multi-hospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow up was included in the trial. Demographic, operative and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio.
RESULTS: Seventeen patients underwent OFB during the defined time period. Demographic data are presented in Table 1. Mean American Society of Anesthesiologists' (ASA) score was 3.25. Mean estimated blood loss (EBL) was 500 milliliters (mL). Mean operative time was 307 minutes. Mean follow-up time was 8.5 months (range 0-35 months). 41.2 percent patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (p-value 0.3). 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. Overall mean length of stay (LOS) was 16.8 days. Two major amputations were reported during follow up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use (IVDU) was not associated with an increased number of subsequent groin wound procedures (p-value 0.3). IVDU was not associated with concomitant methicillin-resistant Staphylococcus aureus (MRSA) infection (p-value 0.3).
CONCLUSION: OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at mid-term follow-up.