Descending Thoracic Aortobifemoral Bypass for Aortoiliac Occlusive Disease

Abstract

Descending thoracic aortobifemoral bypass was evaluated in 3 patients with Leriche's syndrome and 1 with severe arteriosclerosis obliterans. Indications for this approach were lack of a suitable site for aortic clamping in 3 and history of laparotomy in 1. Duration of surgery was 4.5 to 5.25 hours, and blood loss was 450 to 1,900 g. There was no surgical mortality. Major morbidity comprised visceral arterial ischemia postoperatively in 1 patient. During a mean follow-up of 60 months (range, 36 to 84 months), 2 limbs of the grafts became occluded. No patient developed proximal propagation of an aortic thrombus. This approach is recommended in selected patients without impaired pulmonary function, when conventional approaches to the abdominal aorta are considered hazardous.