A Novel Anterior Subcutaneous Tunnel of Thoracic Aorto Bifemoral Artery Bypass for Aortoiliac Occlusive Disease

Abstract

Bypass grafting from the descending thoracic aorta to the iliac or femoral arteries initially was used as a remedial reconstruction for aortic graft failure, graft infection, or other intra-abdominal catastrophes. Although descending thoracic aorta to iliofemoral artery bypass grafting as a secondary reconstruction is well described, its role as a primary procedure remains controversial. In a 3-year period from June-2021 to June-2024, 35 patients were treated with descending thoracic aortobifemoral bypass through anterior subcutaneous tunnel approach at the Department of Vascular surgery, BSMMU. Age ranged from 54 to 82 years with male to female ratio of 6.7:1, symptoms ranged from intermittent claudication (25 cases), rest pain (3 cases) and non-healing ulcer (3 cases). Indications for this approach were; infrarenal aortic block with no site for infrarenal aortic clamping (18 cases), calcified infrarenal aorta (11 cases) and history of laparotomy (2 cases). Duration of surgery was 1.5 to 3 hours and blood loss was 300ml to 1000ml. There was mortality of 2 patients. Reexploration due to bleeding was done in 3 patients and 3 patients required prolonged ventilatory support for 2 days. This approach is recommended in selected patients where conventional approach to the abdominal aorta is not feasible. Follow up of 27 patients had patent grafts in 24 patients and blocked grafts with no symptoms in 3 patients. 2 patients were lost to follow up.