Thoracobifemoral bypass for radiation-induced paravisceral aortic stenosis

Radiation-induced arterial disease is a delayed complication of childhood cancer therapy. We present the case of a 56-year-old man with disabling claudication secondary to severe paravisceral aortic stenosis, attributed to abdominal radiation for Wilms tumor in early childhood. Extensive periaortic fibrosis and calcification precluded endovascular repair and conventional aortobifemoral bypass. He underwent successful thoracobifemoral bypass via a left anterolateral thoracotomy approach and retroperitoneal tunneling of the graft. This case highlights the challenges of managing radiation-associated vascular disease. In select patients, thoracobifemoral bypass offers a durable solution when traditional approaches are contraindicated owing to hostile intraabdominal anatomy.