Several alternative methods are available for aortoiliac revascularization when the standard approach is contraindicated or hazardous. In these circumstances, axillofemoral bypass is favored, but the long-term patency is inferior and is generally reserved for higher-risk patients. Better inflow with improvement in long-term results can be achieved using a more proximal aortic source from the supraceliac, or ascending or descending thoracic aorta. All of these alternatives provide excellent inflow and the patency rates are comparable. The final choice will depend upon the surgeon's personal preference. The descending thoracic aorta-to-femoral bypass is a useful technique in selected, younger, low-risk vascular patients. It is a valuable option when the transabdominal approach to the infrarenal aorta is difficult, such as after prior removal of an infected aortic graft. Relative indications include multiple previous laparotomies or multiple aortic reoperations, a densely scarred retroperitoneum, or heavy calcification or ectasia of the abdominal aorta.
1. Kalman PG, Hosang M, Cina C, et al: Current indications for axillounifemoral and axillobifemoral bypass grafts. J Vasc Surg5:828-832, 1987.
2.
2. Szilagyi DE, Elliott JP Jr, Smith RF, et al: A 30-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J Vasc Surg3:421-436, 1986.
3.
3. Nevelsteen A, Wouters L, Suy R: Aortofemoral Dacron reconstruction for aortoiliac occlusive disease: A 25-year survey. Eur J Vas Surg5:179-186, 1991.
4.
4. Kalman PG, Johnston KW, Walker PM: Descending thoracic aortofemoral bypass as an alternative for aortoiliac revascularization. J Cardiovasc Surg32:443-446, 1991.
5.
5. Rosenfeld JC, Savarese RP, DeLaurentis DA: Distal thoracic aorta to femoral artery bypass: A surgical alternative. J Vasc Surg2:747-750, 1985.
6.
6. Bowes DE, Youkey JR, Pharr WP, et al: Long term follow-up of descending thoracic aorto-iliac/femoral bypass. J Cardiovasc Surg31:430-437, 1990.
7.
7. Criado E, Johnson G, Burnham SJ, et al: Descending thoracic aorta-to-iliofemoral bypass as an alternative to aortoiliac reconstruction. J Vasc Surg15:550-557, 1992.
8.
8. McCarthy WJ, Mesh CL, McMillan WD, et al: Descending thoracic aorta-to-femoral artery bypass: Ten years' experience with a durable procedure. J Vasc Surg17:336-348, 1993.
9.
9. Hussain SA: Descending thoracic aorta to bifemoral by-pass graft without laparotomy. Int Surg73:263-266, 1988.
10.
10. Haas KL, Moulder PV, Kerstein MD: Use of thoracic aortobifemoral artery bypass grafting as an alternative procedure for occlusive aortoiliac disease. Am Surg51:573-576, 1985.
11.
11. Branchereau A, Espinoza H, Rudondy P, et al: Descending thoracic aorta as an inflow source for late occlusive failures following aortoiliac reconstruction. Ann Vasc Surg5:8-15, 1991.
12.
12. Stevenson JK, Sauvage LR, Harkins HN: A bypass homograft from thoracic aorta to femoral arteries for occlusive vascular disease: case report. Ann Surg27:632-637, 1961.
13.
13. Blaisdell FW, DeMattei GA, Gauder PJ: Extraperitoneal thoracic aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis. Am J Surg102:583-585, 1961.
14.
14. Robicsek F, McAll MM, Sanger PW, et al: Case reports: recurrent aneurysm of the abdominal aorta: insertion of a vascular prosthesis from the distal aortic arch to the femoral arteries. Ann Thor Surg3:549-552, 1967.
15.
15. Reichle FA, Tyson RR, Soloff LA, et al: Salmonellosis and aneurysm of the distal abdominal aorta: Case report with a review. Ann Surg171:219-228, 1970.
16.
16. Froysaker T, Skagseth E, Dundas P, Hall KV: Bypass procedures in the treatment of obstructions of the abdominal aorta. J Cardiovasc Surg14:317-321, 1973.
17.
17. Finseth F, Abbott WM: One-stage operative therapy for salmonella mycotic abdominal aortic aneurysm. Ann Surg179:8-11, 1974.
19. Buxton B, Simpson L, Johnson N, et al: Descending thoracic aortofemoral bypass for distal aortic reconstruction after removal of an infected Dacron prosthesis. Med J Aust2:133-136, 1976.
20.
20. Lakner G, Lukacs L: High aortoiliac occlusion: Treatment with thoracic aorta to femoral arterial bypass. J Cardiovasc Surg24:532-534, 1983.
21.
21. Schellack J, Fulenwider JT, Smith RB III: Descending thoracic aortofemoral-femoral bypass: A remedial alternative for the failed aortobifemoral bypass. J Cardiovasc Surg29:201-204, 1988.
22.
22. Bradham RR, Locklair PR Jr, Grimball A: Descending thoracic aorta to femoral artery bypass. J South Carolina Med Assn June:283-286, 1989.
23.
23. O'Brien D, Waldron RP, McCabe JP, et al: Descending thoracic aorto-bifemoral bypass graft: a safe alternative in the high risk patients. Ir Med J84:58-59, 1991.
24.
24. Baird RJ, Ropchan GV, Oates TK, et al: Ascending aorta to bifemoral bypass-a ventral aorta. J Vasc Surg3:405-410, 1986.
25.
25. Franz SL, Kaplitt MJ, Beil AR, et al: Ascending bilateral femoral artery bypass for the totally occluded abdominal aorta. Surgery75:471-475, 1974.
26.
26. Wukasch DC, Cooley DA, Sandford FM, et al: Ascending aorto-abdominal aorta bypass: Indications, technique and report of 12 patients. Ann Thorac Surg23:442-448, 1977.
27.
27. Cooley DA, Wukasch DC: Techniques in Vascular Surgery. Philadelphia: Saunders, 1979.
28.
28. May J, Harris J: Use of the supraceliac abdominal aorta for repeat aortic surgery. In: Bergan JJ, Yao JST (eds). Re-operative Aortic Surgery, Grune & Stratton, New York, pp 175-193, 1986.
29.
29. Canepa CS, Schubart PJ, Taylor LM Jr, et al: Supraceliac aortofemoral bypass. Surgery101:323-328, 1987.
