Descending Thoracic Aorta—to—Femoral Artery Bypass

Results of Lower Limb Revascularization from the Descending Thoracic Aorta

“…10,[16][17][18]31 A prosthesis route that crosses the diaphragm at the level of the crux and then passes dorsal to the kidney in the peritoneum (Fig. 4) seems more compatible and more direct than those described by Enon et al 15 or by McCarthy et al, 20 in which the prosthesis crosses the diaphragm laterally along the anterior axillary line. Similarly, the approach through thoracophrenolaparotomy, which Ochsner 37 describes, is more aggressive, and we have used it only when treating a pseudoaneurysm of the proximal anastomosis of an aortobifemoral bypass graft.…”

“…Out of the 21 deaths registered, 19 occured in three series that included a high percentage of redo patients. 20,24,32 Few long-term complications attributable to bypasses arising from the thoracic aorta have been reported. An aneurysmal growth at the level of the prosthetic implantation, an instance of which we observed, is not documented by other authors.…”

Thoracobifemoral bypass for infrarenal aortic occlusion caused by retroperitoneal fibrosis

“…Much has been written about the unusual and anatomically complex tunnel that must be created for thoracobifemoral bypass grafting. 14,15,21,27,28 The Dacron graft is typically routed bluntly through an incision in the paravertebral posterior diaphragm, in the left retroperitoneum J o u r n a l P r e -p r o o f 7 posterior to the kidney, lateral to the left iliac artery on the surface of the left psoas, then under the left inguinal ligament for anastomosis to the left common femoral artery. The right leg is typically revascularized via femoro-femoral bypass.…”

“…Use of the thoracic aorta as inflow for aortobifemoral bypass was introduced in 1961 12 , 13 and popularized over the ensuing decades. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 The procedure was originally indicated for patients with critical limb ischemia in the presence of a hostile abdomen from prior surgery, irradiation, or infection. Although technically demanding, the operation proved durable with extended long-term patency and acceptable operative morbidity.…”

On‐pump coronary artery bypass with concomitant descending thoracic aorta‐bi‐iliac bypass: A case report

“…Since its first description by Blaisdell et al, 1 various thoracic aorta‐bifemoral bypass techniques have been described 2–4 . These techniques provide a safe approach with good outcomes for treating juxtarenal aortic occlusions, preventing laparotomy‐related complications, and using the less atherosclerotic thoracic aorta as an inflow source 5 .…”