DESCENDING THORACIC AORTA-TO-FEMORAL ARTERY BYPASS GRAFTS

BACKGROUND: Descending thoracic aorta-to-femoral artery (DTAFA) bypass graft is an alternative procedure to revascularize lower limbs, METHO DS: Between 1976 and 1996, 41 patients underwent DTAFA bypass grafts. Operative indications consisted of previous abdominal graft thrombosis (22 cases, group 1), abdominal operations (8, group 2), initial vascu lar operation in the presence of difficult aortas (6, group 3), and in fection of aortic grafts (5, group 4). RESULTS: Perioperative mortalit y was 5%. Cumulative 10-year primary patency, limb salvage, and surviv al rates were 64%, 79%, and 55%, respectively. Breaking down the resul t on the basis of the four groups, DTAFA bypass grafts performed for i nfection of previous aortic grafts had a significantly lower primary p atency rate (25% at 24 months; P < 0.004) with dismal limb salvage (31 % at 24 months; P < 0.001) and survival rates (0% at 24 months; P < 0. 005). CONCLUSIONS: DTAFA bypass grafts can be safely and durably used in patients who had thrombosis of previous abdominal grafts or had a d ifficult abdomen or as the initial vascular operation in the presence of difficult aortas. Conversely, dismal results are obtained in the tr eatment of aortic graft infection. (C) 1997 by Excerpta Medica, Inc.