Descending thoracic aorta-to-femoral artery bypass

Descending thoracic aorta-to-femoral artery grafts were placed in 13 patients who had abdominal aortas deemed undesirable for surgical treatment. These included seven patients in whom an infected aortic graft had been removed for primary graft infection (three) or aortoduodenal fistula (four). These patients had been treated initially with axillary-femoral grafts. In five other patients, this approach was used following failure of at least two previous aortofemoral grafts. The remaining patient was so treated following multiple complex abdominal operations. The surgical technique involves a posterolateral, seventh interspace thoracoabdominal incision with a transdiaphragmatic retroperitoneal tunnel to the left groin. There was no operative mortality. The mean follow-up of all patients was 22 months (range, one to 44 months). All grafts remained patent except one, which was removed because of ascending groin infection. Three patients died, at 24, 29, and 44 months postoperatively, respectively. Reasonable perioperative morbidity and reliable patency make this an attractive technique for the conversion of axillofemoral bypasses and, when reentry of the abdominal cavity is undesirable, laparotomy is avoided.