Extrathoracic axillary-iliac bypass substitution of a resected descending thoracic aorta

Resection of a dissecting aneurysm of the descending thoracic aorta (Type III) was accomplished in a uremic patient on hemodialysis with reconstruction of blood flow through extrathoracic bilateral axillary-subclavian-iliac Dacron grafts. Review of the literature revealed no similar operation reported before. Other potential uses for this operation, such as infected aortic grafts and resections of the arch and descending thoracic aorta in high-risk patients, are discussed. Despite complete rehabilitation of this patient 10 months after operation, the application of this procedure must await longer term follow-up. The operative procedure described thus far was applied only in one patient and should be considered only in special circumstances, as discussed.