Thoraco Femoral Bypass for Aorto Iliac Occlusive Disease

Descending thoracic aorta to femoral artery bypass should be considered in good risk patients for symptoms of chronic functional intermittent claudication or critical limb ischemia in whom standard aortofemoral reconstruction cannot be performed. Patients with a prior history of multiple abdominal operations and failed prior infrarenal aortic reconstruction or an infected aortic prosthesis may be considered for thoracic aorta to femoral bypass provided their cardiopulmonary is satisfactory. Proximal aortic anastomosis is performed through a limited thoracotomy preferably in the eight intercostal space, and bifurcated graft is tunneled through the diaphragm behind the kidney via a retroperitoneal tunnel made through the left groin incision with a tunnel made anterior to iliac vessels and psoas major muscle. Another tunnel behind the rectus abdominis muscle in the preperitoneal space is required to bring the right limb of the graft for anastomosis to the right femoral artery, or alternatively a standard straight graft from distal thoracic aorta to left femoral artery is performed, and a crossover graft from left common femoral artery to the contralateral femoral artery is performed through a standard subcutaneous tunnel in the suprainguinal and suprapubic area.