Thoracofemoral (Thoracic Aortofemoral) Bypass

Updated: Apr 18, 2018
  • Author: Dale K Mueller, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Overview

Background

The typical treatment for aortoiliac occlusive disease is an aortofemoral bypass graft, with patency rates of approximately 83-92% at 5 years. [1] Less invasive approaches have been studied. [2, 3] Thoracofemoral (thoracic aortofemoral) bypass is an alternative surgical bypass that is indicated for aortoiliac occlusive disease when traditional aortobifemoral bypass is contraindicated. [4] These conditions occur when performing a transabdominal or retroperitoneal abdominal procedure is difficult or impossible, as may be the case, for example, in the following circumstances:

  • Prior abdominal irradiation
  • Multiple abdominal interventions
  • Proximal aortic disease in close proximity or above the renal arteries
  • Failure or infection of previous abdominal aortic surgery

Some surgeons have advocated thoracofemoral bypass as a primary treatment for isolated aortoiliac occlusive disease, at least when the disease is in close proximity to the visceral or renal arteries. [1] Reported patency rates for thoracofemoral bypass rival the traditional aortofemoral bypass, at approximately 81% at 5 years. [1]

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Indications

Indications for thoracofemoral bypass include the following:

  • Aortic graft failure [5]
  • Graft infection
  • Hostile abdomen [6]
  • Occlusive disease in close proximity to the visceral or renal arteries
  • Other intra-abdominal pathologies not amenable to standard aortofemoral revascularization

Although some advocate the use of thoracofemoral bypass as a primary procedure, most surgeons consider it a secondary procedure with the previous indications. [1]

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Contraindications

Contraindications for a thoracofemoral bypass graft include the following:

  • Severe pulmonary insufficiency in a patient who is hence unable to tolerate a thoracotomy
  • Unapproachable thoracic aorta

A limiting factor is a prior thoracic operation that precludes or complicates the approach to the descending aorta.

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