Descending Thoracic Aorta as an Inflow Source for Late Occlusive Failures Following Aortoiliac Reconstruction

Branchereau, A; Espinoza, Hugo; Rudondy, P; Magnan, Pierre Édouard; Reboul, Jean

doi:10.1007/bf02021770

Cited by 20 publications

(3 citation statements)

References 13 publications

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“…Although there is a paucity of contemporary information about TFB outcomes, there are some notable historical series (Table IV). Branchereau and colleagues reviewed publications before 1993 and concluded that results from series including 10 or more patients suggested a 10% mortality rate 36 . However, the series that were reviewed included patients with mycotic and non-mycotic indications which undoubtedly biased the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Contemporary outcomes of thoracofemoral bypass

Crawford

Scali

Giles

et al. 2019

Journal of Vascular Surgery

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Objectives: Thoracofemoral bypass (TFB) is an alternative to aorto-femoral (AFB) or extraanatomic bypass for severe aorto-iliac occlusive disease (AIOD). TFB may be particularly useful in select patients with concurrent visceral aortic branch vessel disease, infrarenal aortic occlusions or after failed AFB. However, there are few contemporary series describing the indications and outcomes for TFB. Therefore, the purpose of this analysis was to review our experience with TFB. Methods: All patients undergoing TFB for occlusive disease from 2002-2017 were reviewed. All subjects underwent left thoraco-retroperitoneal exposure of the supra-celiac aorta with division of the diaphragmatic crus and supra-celiac cross-clamping. An end-to-side aortic anastomosis was created and each graft limb was tunneled in the retroperitoneum to the femoral bifurcation. Adjunctive visceral/infra-inguinal revascularization was selectively performed based on symptoms, end-organ function and/or preoperative imaging. The primary end-points were major complications and 30-day mortality. Secondary end-points included limb patency, freedom from major adverse limb events (MALE), and survival. Kaplan-Meier methodology was used to characterize end-points. Results: Forty-one patients [age: 61±9 years; female-54%, hypercoaguable state-7%] underwent TFB. Mean preoperative ankle brachial index (ABI) was 0.4, bilaterally. Indications included: critical limb ischemia (56%), claudication (30%), acute limb ischemia (7%) and combined AIOD +mesenteric ischemia (7%). Seven (17%) had previously undergone AFB and 15(38%) underwent any prior aortic operation. Adjunctive visceral bypass occurred in 8(20%) (14 grafts: renal-6, superior mesenteric artery-5, celiac-3). Postoperative LOS was 11 [IQR 7, 16] days and 30-day mortality was 5% (n=2). Major complications occurred in 34% (n=14; pulmonary-15%, cardiac-12%, bleeding-7% [accidental splenectomy-5%], renal-5%, wound-2%). Mean postoperative ABI was 0.9, bilaterally.

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Section: Discussionmentioning

confidence: 99%

Contemporary outcomes of thoracofemoral bypass

Crawford

Scali

Giles

et al. 2019

Journal of Vascular Surgery

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“…Most reports favor a bifurcated graft6'7'9 rather than a left thoracofemoral graft and a femorofemoral crossover.4, 5 8 The preferred tunneling route for the right limb when a bifurcation graft is used is through the space of Retzius.6'7'9 Finally, it appears that most authors do not use the additional flank incision to simplify and assist graft tunneling,6-9 although some authors have reported no additional morbidity to this incision. 4,5,11 Summary Inflow from the thoracic aorta is infrequently required but is a valuable option in selected cases when a standard ABF is contraindicated or not feasible. The descending thoracofemoral bypass was first described in 1961 in two case reports12,13 and subsequently reported by several authors.6-10,14-23 The thoracic aorta is a good inflow option because exposure is relatively straightforward and this segment is usually free of significant atherosclerosis.…”

Section: Thoracofemoral Bypass: Surgicalmentioning

confidence: 99%

Thoracofemoral Bypass: A Useful Addition to a Vascular Surgeon's Armamentarium

Kalman¹

2004

Perspectives in Vascular Surgery and Endovascular Therapy

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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.

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“…Shortly after these communications, the development and popularization of the axillofemoral bypass for extraanatomic aortoiliac reconstruction dissipated interest in the use of the descending thoracic aorta as an inflow source. Therefore during the next 20 years only two small series and a few case reports describing variations of the original techniques were published, a-9 Furthermore, until January of 1991 only five series were reported of 10 or more patients with descending thoracic aorta to iliofemoral artery bypass grafts (thoracofemoral bypass)) °- 14 During the last 2 decades axillofemoral bypass has been the most widely used alternative for aortoiliac reconstruction in patients in whom the abdominal approach is contraindicated or unduly risky, or in whom survival is judged to be limited. Meanwhile, thoracofemoral bypass has remained ignored.…”

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confidence: 99%

Descending thoracic aorta-to-iliofemoral artery bypass as an alternative to aortoiliac reconstruction

Johnson¹,

Burnham²,

Buehrer³

et al. 1992

Journal of Vascular Surgery

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During the last 3 decades subcutaneous extraanatomic bypass, despite its limited durability, has been the favored alternative to infrarenal aortofemoral bypass. Meanwhile, the descending thoracic aorta has been scarcely used as an inflow source for aortoiliac reconstruction. Over the past 8 years we performed 16 bypasses from the descending thoracic aorta to the iliofemoral vessels for occlusive disease. Our experience combined with that found in the English-language literature totaled 141 patients. In 79 patients (56%) the indication for surgery was failure or infection of an abdominal aortofemoral graft. Previous abdominal operations, sepsis, radiation therapy, the presence of abdominal stomas, or an unsuitable infrarenal aorta were the indications in the remaining cases. The combined operative mortality rate was 6.4%. The life-table primary graft patency was 98% at i year, 88% at 2 years, and 70.4% at 5 years. Bypass from the descending thoracic aorta to the iliofemoral artery uses an inflow source superior to other extraanatomic reconstructions, does not require aortic cross-clamping, avoids the abdominal cavity, and places the graft remote to the skin and intestine. The operative mortality and patency rates compare favorably to those of other extraanatomic or remedial aortic reconstructions. Descending thoracic aorta to iliofemoral artery bypass is a superb alternative to abdominal aortofemoral bypass, carries a low mortality rate, has an excellent short-term patency, and features unique characteristics for long-term durability.

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Descending Thoracic Aorta as an Inflow Source for Late Occlusive Failures Following Aortoiliac Reconstruction

Cited by 20 publications

References 13 publications

Contemporary outcomes of thoracofemoral bypass

Contemporary outcomes of thoracofemoral bypass

Thoracofemoral Bypass: A Useful Addition to a Vascular Surgeon's Armamentarium

Descending thoracic aorta-to-iliofemoral artery bypass as an alternative to aortoiliac reconstruction

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