Thoracofemoral (Thoracic Aortofemoral) Bypass

Updated: Nov 28, 2016
  • 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]  Thoracofemoral (thoracic aortofemoral) bypass is an alternative surgical bypass that is indicated for aortoiliac occlusive disease when aortobifemoral bypass is contraindicated. These conditions occur when performing a transabdominal or retroperitoneal abdominal procedure is difficult or impossible (as may be the case, for example, with prior abdominal irradiation, multiple abdominal interventions, colostomy, proximal aortic disease in close proximity or above the renal arteries, and 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 and/or renal arteries of the aorta. [2]  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 [3]
  • Graft infection
  • Hostile abdomen [4]
  • Occlusive disease in close proximity to the visceral and/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. [2]

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Contraindications

Contraindications to 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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