Thoracofemoral (Thoracic Aortofemoral) Bypass Technique

Updated: Nov 28, 2016
  • Author: Dale K Mueller, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Technique

Bypass From Thoracic Aorta to Femoral Arteries

A left thoracotomy (except with sinus invertus) is performed through the seventh, eighth, or ninth rib space. The inferior pulmonary ligament is taken down and the left lower lobe retracted to expose the distal descending thoracic aorta. Standard exposure is done for the femoral vessels. Most surgeons tunnel the graft through a small incision in the diaphragm and pass the graft retroperitoneally to the left femoral vessel. [1]

A standard femoral-femoral tunnel for the right femoral artery is otherwise performed if necessary; alternatively, this portion of the graft can be placed preperitoneally, because of the potential for kinking if it is passed from the left groin to the right. Some authors recommend carrying the intercostal incision across the costal margin or even performing a thoracoabdominal incision. [1, 5]

Most tunnel the graft posteriorly to the kidney, though a technique has been described in which the graft is tunneled anterior to the left kidney. In the author's view, blind tunneling posterior to the left kidney appears to be the simplest approach.

The anastomosis to the descending thoracic aorta is performed in an end-to-side fashion, usually with a side-biting clamp (though proximal and distal clamping of the descending aorta may be necessary). The graft is angled in such a way as to be directed to the previously created tunnel, then clamped after the thoracic aortic clamps have been released. Standard femoral anastomoses are then constructed. [1]  A thoracoscopic method has also been described that involves stapling the thoracic anastomosis. [6]

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Complications

Complications of thoracofemoral bypass include the following:

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