Descending thoracic aortobifemoral bypass in the management of aortic occlusive disease in surgically fit patients: ‘the forgotten operation’

Aim of the work
To study the efficacy of using the descending thoracic aorta as the inflow artery for patients with aortoiliac occlusions regarding its morbidity, mortality, and patency rate.
Patients and methods
This is a prospective study done in Cairo University Hospitals from May 2014 till November 2018 using the descending thoracic aortobifemoral bypass. Inclusion criteria included surgically fit patients with juxtrarenal aortic occlusion or hostile abdomen. Exclusion criteria included unfit surgical patients and/or no adequate runoff vessel and/or contraindications for thoracotomy.
Results
This study included 15 patients, who underwent descending thoracic aortobifemoral bypass, with 12 male and three female patients, with a patient mean age of 61 years. Patient presentations were disabling claudication pain in eight (53.3%) patients, rest pain in four (26.7%) patients, and tissue loss in three (20%) patients. Indications of intervention were juxtarenal aortic block in nine (60%) patients and hostile abdomen in six (40%) patients. Estimated blood loss ranged from 500 to 900 ml. The duration of the ICU stay ranged from 1 to 4 days (mean, 1.8 days) and the total hospital stay ranged from 5 to 10 days (mean, 8.2 days). Clinical improvement was evident in all 15 (100%) patients. No mortality was reported in our study. Procedure-related complications occurred in four (26.7%) cases; one case developed dehiscence of the abdominal wall, two cases of pneumonia, and one patient suffered from groin wound gapping. Primary patency rate at 12 months was 100% with no major amputations.
Conclusion
Thoracobifemoral bypass offers a good alternative to aortofemoral bypass due to less embolization and good patency rate. We recommend its use as an alternative procedure in fit patients with juxtarenal aortic occlusive disease or failed previous aortic bypass surgery.