Early Outcomes of Thoracofemoral Bypass for Aortoiliac Occlusive Disease: A 10-Year Single-Center Experience

Abstract

Introduction

Thoracofemoral bypass is primarily utilized as a secondary intervention for juxtarenal aortoiliac occlusive disease, with limited instances of its application as an initial treatment, leading to uncertain long-term outcomes. This analysis aims to scrutinize the 10-year experience and early outcomes of 90 patients who underwent thoracofemoral bypass as a primary procedure.

Materials and Methods

A retrospective analysis was conducted on patients undergoing thoracofemoral bypass for severe aortoiliac occlusive disease between August 2012 and August 2022. The primary indication was complete abdominal aorta obstruction at the renal artery level with an unsuitable site for aorta clamping. The BARD IMPRA expanded polytetrafluoroethylene vascular graft was employed for thoracobifemoral bypass surgery.

Results

Among the 90 patients, 83 (92.22%) were male, and 7 (7.78%) were female, with ages ranging from 51 to 77 years. Intraoperative and postoperative data were analyzed, and the mean follow-up duration was 30 days. The 30-day mortality rate was 3.33% (n = 3). Major morbidities included graft occlusion in one patient, managed by embolectomy, and ascites in another patient, addressed conservatively.

Conclusion

This study demonstrates that thoracic aorta to femoral artery bypass, as a simple extra-anatomic bypass technique, can yield favorable outcomes when chosen as the initial treatment for patients with juxtarenal total aortoiliac occlusive disease. Thoracofemoral bypass exhibits a safe, acceptable outcome with reliable patency.

Keywords

atherosclerosis - peripheral vascular disease - thoracobifemoral bypass

Publikationsverlauf

Eingereicht: 27. Januar 2024

Angenommen: 06. November 2024

Artikel online veröffentlicht:
12. Juni 2025

• References

• 1 de Cort BA, Salemans PB, Fritschy WM, Pierie MEN, Lind RC. Long-term outcome for covered endovascular reconstruction of aortic bifurcation for aortoiliac disease: a single-center experience. J Endovasc Ther 2021; 28 (06) 906-913
• 2 Norgren L, Hiatt WR, Dormandy JA. et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease. Int Angiol 2007; 26 (02) 81-157
• 3 Lemaire SA, Jones MM, Conklin LD. et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg 2009; 49 (01) 11-19 , discussion 19
• 4 Passman MA, Farber MA, Criado E, Marston WA, Burnham SJ, Keagy BA. Descending thoracic aorta to iliofemoral artery bypass grafting: a role for primary revascularization for aortoiliac occlusive disease?. J Vasc Surg 1999; 29 (02) 249-258
• 5 Sarıkaya S, Aksoy E, Tasar M. et al. Thoracic aortofemoral artery bypass: an alternative procedure for initial treatment of critical aortoiliac occlusive disease. Turk Gogus Kalp Damar Cerrahisi Derg 2013; 21: 49-53
• 6 Crawford JD, Scali ST, Giles KA. et al. Contemporary outcomes of thoracofemoral bypass. J Vasc Surg 2019; 69 (04) 1150-1159.e1
• 7 Stevenson JK, Sauvage LR, Harkins HN. A bypass homograft from thoracic aorta to femoral arteries for occlusive vascular disease. Am Surg 1961; 27: 632-637
• 8 Blaisdell FW, Demattei GA, Gauder PJ. Extraperitoneal thoracic aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis. Am J Surg 1961; 102: 583-585
• 9 Nunesa C, Pereiraa RV, Pedrosab JO. et al. Descending thoracic aorta as inflow for primary revascularization of aorto-iliac occlusive disease – review of the last 30 years. Angiol Vasc Surg 2023; 19 (03) 178-182
• 10 Sapienza P, Mingoli A, Feldhaus RJ. et al. Descending thoracic aorta-to-femoral artery bypass grafts. Am J Surg 1997; 174 (06) 662-666
• 11 Ihaya A, Chiba Y, Kimura T, Morioka K, Uesaka T. Descending thoracic aortobifemoral bypass for aortoilliac occlusive disease. Asian Cardiovasc Thorac Ann 2001; 9: 97-100
• 12 Sharma A, Sharma M, Dixit S, Sharma N, Sharma O. Descending thoracic aorto-bifemoral bypass for aortoiliac occlusive disease. Indian Journal of Vascular and Endovascular Surgery. 2015; 2 (01) 12-15
• 13 Shah A, Sharma A, Dixit S. et al. Combined coronary artery bypass with descending thoracic aorta to bifemoral bypass grafting using minimal invasive technique. Indian J Thorac Cardiovasc Surg 2024; 40 (02) 231-233