Thoracofemoral (Thoracic Aortofemoral) Bypass
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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:
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]
Indications for thoracofemoral bypass include the following:
Although some advocate the use of thoracofemoral bypass as a primary procedure, most surgeons consider it a secondary procedure with the previous indications. [1]
Contraindications for a thoracofemoral bypass graft include the following:
A limiting factor is a prior thoracic operation that precludes or complicates the approach to the descending aorta.
Schneider JR. Aortoiliac disease: extra-anatomic bypass. Cronenwett JL, Johnston KW, eds. Rutherford’s Vascular Surgery. 8th ed. Philadelphia: Elsevier Saunders; 2014. Vol 2: 1722-42.
Maldonado TS, Westin GG, Jazaeri O, Mewissen M, Reijnen MM, Dwivedi AJ, et al. Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft. Eur J Vasc Endovasc Surg. 2016 Jul. 52 (1):64-74. [Medline]. [Full Text].
Dorigo W, Piffaretti G, Benedetto F, Tarallo A, Castelli P, Spinelli F, et al. A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease. J Vasc Surg. 2017 Jan. 65 (1):99-107. [Medline].
Blair KSA, Bassiouny H. Thoracofemoral bypass. Hoballah JJ, Scott-Conner CEH, Chong HS, eds. Operative Dictations in General and Vascular Surgery. 3rd ed. Cham, Switzerland: Springer; 2017. 697-700.
Koksal C, Kocamaz O, Aksoy E, Cakalagaoglu C, Kara I, Yanartas M, et al. Thoracic aortobifemoral bypass in treatment of juxtarenal Leriche syndrome (midterm results). Ann Vasc Surg. 2012 Nov. 26 (8):1085-92. [Medline].
Lee HK, Kim KI, Lee WY, Kim HS, Lee HS, Cho SW. Descending thoracic aorta to bilateral femoral artery bypass in a hostile abdomen. Korean J Thorac Cardiovasc Surg. 2012 Aug. 45 (4):257-9. [Medline].
McCarthy WJ, Mesh CL, McMillan WD, Flinn WR, Pearce WH, Yao JS. Descending thoracic aorta-to-femoral artery bypass: ten years’ experience with a durable procedure. J Vasc Surg. 1993 Feb. 17(2):336-47; discussion 347-8. [Medline].
McMillan WD, McCarthy WJ. Minimally invasive thoracoscopic thoraco-femoral bypass: a case report. Cardiovasc Surg. 1999 Mar. 7(2):251-4. [Medline].
Dale K Mueller, MD Co-Medical Director of Thoracic Center of Excellence, Chairman, Department of Cardiovascular Medicine and Surgery, OSF Saint Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, Ltd, A Subsidiary of OSF Saint Francis Medical Center; Section Chief, Department of Surgery, University of Illinois at Peoria College of Medicine
Dale K Mueller, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, Chicago Medical Society, Illinois State Medical Society, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons, Rush Surgical Society
Disclosure: Received consulting fee from Provation Medical for writing.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
Thoracofemoral (Thoracic Aortofemoral) Bypass
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