Related Experiment Videos
Descending thoracic aortofemoral bypass as an alternative for aortoiliac revascularization
P G Kalman1, K W Johnston, P M Walker
1Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
Insights
Descending thoracic aorta to femoral bypass is a safe alternative for patients unsuitable for abdominal aortic surgery. This procedure demonstrated excellent graft patency and is a viable option for complex lower extremity revascularization.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
- Surgical Innovation
Background:
- Standard transabdominal approaches for aortic bypass may be contraindicated or hazardous in select patients.
- Reoperations on the abdominal aorta can present significant surgical risks.
- Axillofemoral bypass failures may necessitate alternative revascularization strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of descending thoracic aorta to femoral bypass as an alternative inflow source.
- To assess the long-term patency rates of thoracofemoral and femorofemoral grafts.
- To determine the suitability of this procedure for patients with contraindications to abdominal aortic surgery.
Main Methods:
- Retrospective review of six patients undergoing descending thoracic aorta to femoral bypass.
- Inflow sourced from the descending thoracic aorta to the left groin, with a femorofemoral bypass to the right groin.
- Assessment of operative mortality, morbidity, and graft patency during follow-up.
Main Results:
- No operative mortality or major morbidity associated with the surgical procedure.
- All thoracofemoral grafts remained patent at an average follow-up of 17.1 months.
- Five of six femorofemoral crossover grafts remained patent; one occlusion related to outflow disease.
Conclusions:
- Descending thoracic aorta to femoral bypass provides reliable inflow and excellent graft patency.
- This procedure is a valuable alternative for patients where abdominal aortic reoperation is undesirable or hazardous.
- Consideration for conversion of failed axillofemoral bypasses is also supported by these findings.
Abstract:
We performed descending thoracic aorta to femoral bypass in six selected patients over the past four years. An alternative inflow source was selected because the standard transabdominal approach was contraindicated or considered hazardous. The inflow consisted of a single Dacron tube from the descending thoracic aorta to the left groin, and a femorofemoral bypass to the right groin. There was no operative mortality or major morbidity related to the surgical procedure. After an average follow-up of 17.1 months (range 6 to 23 months), all thoracofemoral grafts remained patent. One patient had repeated occlusions of the femorofemoral graft related to right lower extremity outflow disease, while the remaining five crossover grafts are patent. One patient died 22 months postoperatively from a myocardial infarct, with a patent bypass. Although this series represents a small group of patients, we feel that descending thoracic aortofemoral bypass offers excellent inflow and reliable patency, and is a good alternative when reoperation on the abdominal aorta is undesirable. This procedure may also be considered for conversion of an axillofemoral bypass that has failed repeatedly.