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Descending thoracic aorta as an inflow source for late occlusive failures following aortoiliac reconstruction
A Branchereau1, H Espinoza, P Rudondy
1Service de Chirurgie Vasculaire, des Hopitaux, Sud Marseille, France.
Insights
Descending thoracic aorta-to-femoral artery bypass surgery offers a viable solution for complex aortoiliofemoral reconstruction failures. This extraanatomic bypass technique demonstrates good secondary patency rates in late-stage cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
- Surgical Outcomes
Background:
- Aortoiliofemoral reconstructive surgery failures necessitate alternative treatment strategies.
- Late graft failures present significant challenges in managing lower limb ischemia.
- Extraanatomic bypasses provide an alternative to re-entering the abdomen for complex cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of descending thoracic aorta-to-femoral artery bypass procedures.
- To assess the feasibility of this technique in patients with failed prior aortoiliofemoral reconstructions.
- To determine graft patency and patient survival rates in this specific patient cohort.
Main Methods:
- A retrospective review of 10 descending thoracic aorta-to-femoral artery bypass procedures performed between November 1984 and March 1990.
- Analysis of patient demographics, indications for surgery, graft types, and postoperative outcomes.
- Evaluation of primary and secondary graft patency, patient survival, and complications.
Main Results:
- The study included 10 male patients with a mean age of 60 years, presenting with various failures of aortoiliofemoral reconstructions.
- Indications included false aneurysms, bypass occlusions, and graft degradation.
- Primary patency was 55.5% (5/9 survivors) and secondary patency was 100% (9/9), with a mean survival time of 14 months.
Conclusions:
- Descending thoracic aorta-to-femoral artery bypass is a feasible and effective method for managing late failures of aortoiliofemoral surgery.
- This extraanatomic bypass technique avoids abdominal re-exploration, simplifying complex reconstructions.
- The procedure demonstrates favorable secondary patency and can restore lower limb perfusion in challenging cases.
Abstract:
From November 1984 to March 1990, 10 descending thoracic aorta-to-femoral artery bypass procedures were performed after failure of one or several aortoiliofemoral reconstructions. All patients were men, mean age 60 years. Indications included noninfected false aneurysm of an infrarenal end-to-side aortoprosthetic anastomosis in one case; one occlusion of an axillofemoral bypass; degradation of an aortobifemoral prosthetic graft; two occlusions of aortofemoral bypass; and five occlusions of aortobiliac or aortobifemoral bypasses. Eight bifurcated grafts, one aortoprosthetic tube graft, and one aortopopliteal tube graft were inserted. One patient died 23 days postoperatively of multiple organ failure. Three patients underwent a successful seconary lower limb reconstruction procedure (prosthetic limb thrombectomy, embolectomy, femoral bifurcation angioplasty in one case each). Mean survival time was 14 months (range 3-48 months). Two patients were lost to follow-up, and one died of myocardial infarction six months postoperatively with a patent bypass. Graft thrombosis occurred in two patients. One was treated by thrombectomy at five months, the other was treated by in-situ thrombolysis at 15 months. Both of these patients had patent grafts at 12 and 21 months, respectively. The four other patients had patent grafts at 48 months. Primary patency was 55.5% (5/9 survivors) and secondary patency was 100% (9/9). This is a relatively simple method for constructing an extraanatomic aortofemoral or aortobifemoral bypass in late failures of aortoiliofemoral reconstructive surgery without having to re-enter the abdomen.