Transiliac bone tunnel route for lower limb vascular reconstruction

Major oncovascular resections involving irradiated or infected groins often preclude standard in-line arterial or venous reconstruction because of hostile local conditions and high reinfection risk. In these complex scenarios, trans-iliac bone tunnel bypass (TIBB) represents an alternative extra-anatomic solution, providing a protected lateral route that avoids contaminated fields while ensuring durable limb perfusion or venous outflow. We describe the technical principles, perioperative management, and clinical applicability of TIBB through two representative cases. The first case involved an arterial reconstruction performed for groin blowout following neoadjuvant radiotherapy and multiple prior graft infections. The second case concerned venous reconstruction after en bloc pelvic oncovascular resection for leiomyosarcoma. The technique is based on retroperitoneal iliac exposure, creation of a 10-mm tunnel through the iliac wing, and lateral routing of a ring-reinforced polytetrafluoroethylene graft in a subcutaneous plane, distant from infected or irradiated tissues. In both cases, TIBB achieved satisfactory hemodynamic results, effective infection control, and durable patency. At mid-term follow-up, arterial reconstruction remained patent without reinfection, whereas venous bypass resulted in significant limb edema reduction and maintained graft patency. These experiences suggest that TIBB is a reproducible and effective limb-salvage strategy in selected oncovascular patients when conventional reconstructive options are unsafe or unfeasible. (J Vasc Surg Cases Innov Tech 2026;12:102209.)