Descending aorta-to-femoral artery bypass: Preliminary experience with a thoracoscopic technique

Descending aorta-to-femoral artery bypass is a durable procedure with excel lent long-term patency rates. The operation is usually performed using a la teral thoracotomy combined with retroperitoneal tunneling of the graft, Ass uming that a smaller incision would reduce the operative trauma, minimally invasive video endoscopic techniques were used to perform a thoracoscopic b ypass operation. In all patients, exposure of the descending aorta was obta ined using thoracoscopy. This was accomplished with a maximum of four parts . For placing the conventional side-biting aortic clamp, a 3- to 4-cm incis ion was necessary. Using this incision as an access pert, the proximal anas tomosis was sutured endoscopically. Retroperitoneal tunneling was performed using laparoscopically guided balloon dissection. Eleven consecutive patie nts underwent surgery. In two patients, conversion to a standard thoracotom y was necessary because of extensive intrathoracic adhesions. There were no major complications, except for one hematoma. After a mean follow-up of 9. 5 months, all bypass grafts were still patent. Patients could be discharged after a mean postprocedural hospital stay of 7.4 days (range, 5-12), Thora coscopic descending aorta-to-femoral artery bypass is an operation with exc ellent patency rates; however, it is a novel technique that still requires further technical improvements. Clinical studies are needed to prove the sa fety and efficacy of this minimally invasive technique.