Ascending Aorta to Bilateral Common Femoral Artery Bypass Grafting for Thrombosis of the Aorta: Case Reports

Abstract

Thrombosis of the abdominal aorta is a recognized entity most commonly due to embolic occlusion of the bifurcation, the presence of an abdominal aortic aneurysm, or the presence of distal aortic occlusive disease. The approach to the embolic occlusion is generally under local anesthesia with balloon embolectomy. We have treated two patients with thrombosis of the aorta secondary to severe aorto-iliac disease, and a third patient with thrombosis of the aorta who had a prior aneurysmectomy and multiple abdominal procedures for pancreatic dis ease. These patients were referred late in the course of their aortic thrombosis and had established lines of demarcation at the abdominal level. To effect rapid establishment of lower extremity circulation and to avoid the intra-abdominal problems associated with re-operative procedures, we utilized the ascending aorta to bilateral common femoral bypass as an alternative mechanism to estab lish prompt vascular integrity. The procedure may be accomplished by the mid sternal splitting approach and utilization of a low porosity dacron prosthesis which is then tunneled subcutaneously into the common femoral area without difficulty. The operative procedure requires less than two hours for the immedi ate establishment of blood flow, and the post-operative convalescence in the hospital is five to seven days. This procedure is easily performed by surgeons dealing with major cardiothoracic procedures and can be utilized as an alterna tive to other more lengthy procedures when rapid establishment of lower ex tremity perfusion is desired in acute aortic thrombosis.