Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularisation technique useful in hostile groin cases. Although described during the 1960s, this operation is often considered technically demanding and not widely used nowadays. This study reports the long term outcomes of a series of OFBs. This was a retrospective, observational, single centre study. All consecutive patients who underwent an OFB between 2002 and 2024 at the Henri Mondor University Hospital were included. Pre-operative patient characteristics, as well as intra-operative and post-operative data were analysed. Primary outcomes were survival and primary and secondary patency. Secondary outcomes were wound healing, freedom from re-infection, and limb salvage. Between 2002 and 2024, 26 patients underwent an OFB; 18 were men (69%). The mean age was 64 ± 12 years. In 21 cases (81%) the surgical indication was extensive groin infection with native vessels or prosthetic material involvement. In six cases (23%), the operation was performed under emergency conditions. A cryopreserved arterial allograft was the conduit of choice in 16 cases (62%). Mean follow up was 37 ± 8 months (range, 0-129). The thirty day mortality rate was 15%. Survival rate at 12, 24, and 36-60 months was 73%, 67%, and 60%, respectively. The primary patency rate was 88% at 12 months and 83% at 24-60 months. An early re-intervention was needed in eight patients (31%), mostly for local wound debridement. There were no cases of bypass re-infection requiring removal. Obturator foramen bypass can be a limb and lifesaving procedure in selected cases and experienced centres. Long term patency and wound healing rates are satisfactory. The authors reported a non-negligible early mortality rate, which is associated with the severe initial condition of these patients, often admitted with septic or haemorrhagic shock, and affected by multiple comorbidities. Thorough knowledge of the technique and continuous post-operative follow up are mandatory to eventually prevent and treat complications.

Paravisceral aortic lesions present significant challenges for endovascular treatment. This retrospective analysis of consecutively treated patients from April 2017 to June 2021 aimed to analyse the outcome of primary intra-operative embolisation of aortic complicated pseudoaneurysms and gutter channels during parallel graft (PG) repair of paravisceral symptomatic aortic pseudoaneurysms. Patients with symptomatic pseudoaneurysms of the paravisceral aorta treated with PGs using chimney or periscope configurations were included. Thoracic endografts were positioned to exclude the aortic lesions. Coil embolisation of both the lesions and gutter channels was performed after graft deployment and prior to ballooning of the stent grafts. The primary endpoints were technical success (defined as exclusion of the pseudoaneurysm, target visceral vessel [TVV] patency, absence of gutter endoleaks) and clinical success (technical success+ resolution of symptoms+ absence of major adverse events) at 30 days. Secondary endpoints included overall survival, TVV patency, gutter endoleaks, and freedom from re-interventions during follow up. Six patients (four women) were treated for pseudoaneurysm rupture (three cases) and symptomatic aortic pseudoaneurysm (three cases) of the paravisceral aorta. The patients' anatomies were unsuitable for off the shelf devices and patients were all deemed to be at prohibitive surgical risk. A total of 15 TVVs were revascularised (comprising three coeliac arteries, five superior mesenteric arteries, and seven renal arteries) using 10 chimney and five periscope PGs. One coeliac artery was occluded. Seventy coils were deployed to embolise both the aortic ruptures and gutter channels. Both technical and clinical success rates were 100%. The median follow up was 17 months (IQR 5, 35), during which time three patients died due to non-aortic related causes. One coeliac artery (6%) was occluded, and no endoleak evidence was found. Primary intra-operative embolisation during parallel graft endovascular repair of paravisceral symptomatic aortic pseudoaneurysms may be both safe and effective in excluding the pseudoaneurysm when other options are unavailable.