[Descending thoracic aorta: an excellent inflow source for recurrent revascularization of the lower limbs]

Although severe complications after anatomic reconstruction of the abdominal aorta are unusual, when they occur, a different strategy is required to treat the patient with success and a distinct operation is generally required for a durable favourable long term outcome. Late complications after abdominal aortic grafting include prosthetic infection, enteric erosion and graft thrombosis. Treatment by resection of the infected graft and extra-anatomic reconstruction with axillary-femoral or axillary-popliteal bypass leaves the patient with an unreliable arterial inflow for his lower extremities; in those patients who survive graft removal and extra-anatomic bypass, an alternative source of major arterial inflow should at least be discussed to effect a permanent repair. The descending thoracic aorta has been described as an ideal inflow source for definitive intracavitary conversion of extra-anatomic subcutaneous bypasses and as an occasional alternative to avoid a densely scarred abdomen or retroperitoneum. Our experience with 8 patients includes 7 in whom the aorta had been overseen below the renal arteries in a previous operation [after removal of infected graft (n = 4) and after repair of aorto-enteric fistula (n = 3)]. Our technique of primary extra-anatomic reconstruction consists of a right-sided axillo-femoral (-popliteal) bypass with femoro-femoral crossing graft. This method avoids tunneling an extra-anatomic graft in the left thoraco-abdominal region, thus facilitating the definitive repair. Preoperative radiographic evaluation of inflow and outflow details is essential in these complex cases.(ABSTRACT TRUNCATED AT 250 WORDS)