Descending thoracic aortofemoral-femoral bypass: a remedial alternative for the failed aortobifemoral bypass

The patient with densely scarred retroperitoneum, multiple previous celiotomies, failed remedial retroperitoneal aortobifemoral graft or multiple extra-anatomic graft failures presenting with limb-threatening ischemia taxes the ingenuity of the most experienced vascular surgeon. Lower extremity revascularization, in these situations, is dependent upon achieving adequate femoral arterial inflow. One remedial alternative method to achieve this goal is the descending thoracic aortofemoral-femoral bypass (DTAF-F). The authors' experience with three recent patients requiring DTAF-F is described, and literature of similar alternative techniques is reviewed.