Kalman P G, Johnston K W, Walker P M
Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
J Cardiovasc Surg (Torino). 1991 Jul-Aug;32(4):443-6.
We performed descending thoracic aorta to femoral bypass in six selected patients over the past four years. An alternative inflow source was selected because the standard transabdominal approach was contraindicated or considered hazardous. The inflow consisted of a single Dacron tube from the descending thoracic aorta to the left groin, and a femorofemoral bypass to the right groin. There was no operative mortality or major morbidity related to the surgical procedure. After an average follow-up of 17.1 months (range 6 to 23 months), all thoracofemoral grafts remained patent. One patient had repeated occlusions of the femorofemoral graft related to right lower extremity outflow disease, while the remaining five crossover grafts are patent. One patient died 22 months postoperatively from a myocardial infarct, with a patent bypass. Although this series represents a small group of patients, we feel that descending thoracic aortofemoral bypass offers excellent inflow and reliable patency, and is a good alternative when reoperation on the abdominal aorta is undesirable. This procedure may also be considered for conversion of an axillofemoral bypass that has failed repeatedly.
在过去四年里，我们为六名选定患者实施了降主动脉至股动脉旁路移植术。由于标准经腹入路存在禁忌或被认为有风险，因此选择了替代的流入源。流入部分包括一根从降主动脉至左腹股沟的单根涤纶管，以及一条至右腹股沟的股-股旁路。手术过程中没有与手术相关的死亡或严重并发症。平均随访17.1个月（范围6至23个月）后，所有胸-股移植物均保持通畅。一名患者因右下肢流出道疾病导致股-股移植物反复闭塞，而其余五条交叉移植物通畅。一名患者术后22个月死于心肌梗死，旁路移植通畅。尽管该系列代表的患者数量较少，但我们认为降主动脉至股动脉旁路移植术提供了良好的流入和可靠的通畅性，并且在不希望对腹主动脉进行再次手术时是一个很好的选择。对于反复失败的腋-股旁路转换，也可考虑该手术。
