Retropubic femorofemoral bypass: A new route through the space of Retzius

A retropubic route through the space of Retzius can serve as a convenient and safe anatomic plane through which a femorofemoral graft can be tunneled. Usually femorofemoral bypasses are carried subcutaneously, anterior to the pubis. Although one would not consider bypasses in this particular position to be as exposed to trauma and external compression as are superficial bypasses in other areas, one of our male patients sustained an occlusion of an autogenous vein femorofemoral arterial bypass at the time of intercourse. We therefore became interested in a more protected route for femorofemoral bypass. Bypass grafts generally follow either the normal anatomic position of the vessel being bypassed or are placed in a subcutaneous position. Concern about superficially positioned bypasses has been apparent in other regions. For example, axillofemoral bypasses are placed subcutaneously. These patients are not able to wear belts and are unable to recline on the side on which the bypass has been cmstructed. Experience with axillofemoral bypasses suggests also the importance of positioning the bypass in order to minimize kinking or telescoping, which may be caused by body motion. Thus, if the axillofemoral bypass is carried somewhat more posteriorly and then gently curved anteriorly to pass medial to the anterior superior spine, there is less chance of occlusion. This arcing route permits gentle