Barrett S G, Bergamini T M, Richardson J D
Department of Surgery, University of Louisville School of Medicine and the Veterans Administration Medical Center, Kentucky 40292, USA.
Am Surg. 1999 Mar;65(3):232-5.
Descending thoracic aortobifemoral bypass is an alternative inflow operation in cases in which standard aortobifemoral or axillobifemoral bypass is not an option. We performed descending thoracic aortobifemoral bypass for failed inflow operations in four patients, prior abdominal/pelvic radiation in two patients, poor quality distal aorta (extensive atherosclerotic disease or poor tissue quality) in two patients, and abdominal sepsis in two patients. Eight have had excellent results with patency at a mean follow-up of 38 months. There was no limb loss. One patient died of organ failure, and one patient with hypercoagulability developed a graft clot. A literature review disclosed that a descending thoracic aortobifemoral bypass was reported to have been performed in 203 patients, with most cases reported in the last decade. This procedure was the primary inflow operation in 42 per cent of cases. Indications for the operation included failed aortic grafts (38%), "hostile" abdomen (21%), infected aortic grafts (18%), and other (23%). The patency rate was 95 per cent at 6 months. Few long-term results are known, but the results appear to be durable. Descending thoracic aortobifemoral bypass is a useful operation in highly selected circumstances in which conventional methods of aortic reconstruction are not available.
降主动脉双股动脉旁路移植术是一种替代的流入道手术，适用于无法进行标准主动脉双股动脉或腋双股动脉旁路移植术的情况。我们对4例流入道手术失败、2例曾接受腹部/盆腔放疗、2例远端主动脉质量差（广泛动脉粥样硬化疾病或组织质量差）以及2例腹部脓毒症的患者进行了降主动脉双股动脉旁路移植术。8例患者效果良好，平均随访38个月时移植血管通畅。无肢体丧失。1例患者死于器官衰竭，1例高凝状态患者发生移植血管血栓形成。文献综述显示，据报道有203例患者接受了降主动脉双股动脉旁路移植术，大多数病例是在过去十年中报道的。该手术在42%的病例中是主要的流入道手术。手术适应证包括主动脉移植失败（38%）、“复杂”腹部（21%）、感染性主动脉移植（18%）以及其他（23%）。6个月时通畅率为95%。已知的长期结果很少，但结果似乎是持久的。降主动脉双股动脉旁路移植术在常规主动脉重建方法不可用的高度特定情况下是一种有用的手术。
