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Thoracic aorta-femoral artery bypass: indications, technique, and late results
Insights
Retroperitoneal thoracic aorta-femoral artery bypass offers a valuable solution for lower limb revascularization. This technique proves effective in patients with abdominal aorta access challenges, demonstrating high patency rates.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
Background:
- Abdominal aortic access can be hazardous for certain patients.
- Previous aortoiliac reconstructions may present challenges for repeat interventions.
Purpose of the Study:
- To evaluate the efficacy and safety of retroperitoneal descending thoracic aorta-femoral artery bypass.
- To assess outcomes in patients with complex aortoiliac disease or prior reconstructions.
Main Methods:
- Retrospective review of 18 patients undergoing retroperitoneal thoracic aorta-femoral artery bypass over 11 years.
- Reconstruction to one or both femoral arteries based on patient anatomy.
- Analysis of indications including infection, occlusion, and hazardous abdominal aorta conditions.
Main Results:
- High cumulative patency rates: 96% at 1 year and 85% at 5 years.
- No significant changes in renal function (serum creatinine, BUN) post-operatively.
- Successful lower limb revascularization in diverse patient groups.
Conclusions:
- Retroperitoneal thoracic aorta-femoral artery bypass is a viable and safe option for lower limb revascularization.
- This approach is particularly useful when abdominal aorta access is compromised or deemed hazardous.
- The technique provides durable patency and preserves renal function.
Abstract:
Retroperitoneal descending thoracic aorta-femoral artery bypass was performed in 18 patients over an 11-year period. The reconstruction was carried to both femoral arteries in 12 patients; in the other 6, only a single femoral artery was revascularized. The operative indication in Group 1 (3 patients) was infection of a previous aortoiliac reconstruction; in Group 2 (12 patients), occlusion of a previous aortoiliac reconstruction; and in Group 3 (3 patients), aortoiliac occlusive disease in which a direct transabdominal procedure was considered hazardous. Follow-up ranged from 6 months to 9 years (mean, 40 months). Cumulative patency rate was 96 +/- 3.9% at 1 year and 85 +/- 8.1% at 5 years. No alterations of serum creatinine and blood urea nitrogen values were recorded seven days and 6 months after operation. Retroperitoneal thoracic aorta-femoral artery bypass is a useful technique for accomplishing lower limb revascularization in patients in whom exposure or availability of the abdominal aorta poses a specific hazard.