‚Circumflex’ arterial bypass for ischaemia of the lower limbs-another imitation of natural collaterals

Occasionally revascularization of the lower limb by direct aortofemoral or iliofemoral bypass graft is impracticable because of sepsis in the femoral triangle. In such cases the femoral triangle has been circumvented by using an alternative route via the obturator foramen for the bypass. It is pointed out that this obturator bypass is simply an imitation of natural collaterals (obturator and medial femoral circumflex arteries), but that it has certain limitations. Another alternative pathway is described and named the ‚circumflex’︁ bypass because it is an imitation of the circumflex collaterals (deep circumflex iliac and lateral femoral circumflex arteries). This bypass has been used successfully in 2 patients-from the common iliac to the superficial femoral in the first, and from the axillary to the superficial femoral in the second.