Use of the Descending Thoracic Aorta as an Inflow Source in Aortoiliac Reconstruction: Indications and Long-Term Results

Abstract

Bypass grafting from the descending thoracic aorta to the iliac or femoral artery is an underutilized procedure; fewer than 200 cases were reported in the past 30 years. Over the last decade we performed 32 bypasses to the femoral iliac or popliteal arteries using the descending thoracic aorta as the inflow source. In 19 (59%) patients the procedure was a primary aortic reconstruction, whereas in 13 (41%) it was secondary. The 30-day in-hospital mortality rate was 6.2%. Primary graft patency was 86% (+/- 7.8) at 2 years. To obtain a meaningful long-term patency analysis, we combined our experience with that reported in the literature during the same period. Follow-up data were available in 146 patients in whom the mean follow-up time ranged from 15 to 53 months. The operation was a secondary aortic reconstruction in 84 (58%) patients and was a primary procedure in 62 (42%). Reasons for the selection of the descending thoracic aorta as the inflow source included previous abdominal aortic graft failure in 56 (38%) patients, abdominal aortic graft infection in 26 (18%), unfavorable abdominal conditions in 30 (21%), and miscellaneous causes in 34 (23%). The 30-day in-hospital mortality rate for the collective experience was 5.5%. Life-table analysis of the collective primary graft patency rate was 88.3% (+/- 2.9) at 1 year, 81% (+/- 4.3) at 3 years, and 72.7% (+/- 8.5) at 6 years. Secondary graft patency for the collective experience was 93.1% (+/- 2.3) at 1 year, 88.2% (+/- 3.7) at 3 years, 82.7% (+/- 7.3) at 6 years, and 82.7% (+/- 10) at 8 years. Patient survival was 67.5% (+/- 6.9) at 5 years and 55.4% (+/- 9.9) at 7 years. These data suggest that bypass from the descending thoracic aorta to the iliac or femoral arteries offers low mortality and excellent durability and should be considered as the procedure of choice for secondary or extra-anatomic aortoiliac reconstruction.