Ascending aorta to bilateral femoral artery graft via a ventral subcutaneous route

Two patients were treated for grossly ischemic legs by a graft from the ascending aorta to both common femoral arteries. After leaving the mediastinum, the graft lay in the subcutaneous position throughout its course. In both patients, standard aorto-femoral repair was considered unduly hazardous because of gross obesity, large incisional hernias, previously unsuccessful vascular procedures, impaired renal function, emphysema, and complete occlusion of the abdominal aorta to the level of the renal arteries. Both patients had evidence of bilateral subclavian artery stenosis or occlusion. The technique of the operation is described and its assets and liabilities discussed. Within strict limitations, it is an alternative to axillo-femoral bypass.