Aortofemoral Bypass

Aortofemoral bypass surgery is a procedure utilized commonly for the treatment of aortoiliac occlusive disease, sometimes referred to as Leriche syndrome. Aortoiliac occlusive disease can contribute to lower extremity ischemic symptoms necessitating intervention. Symptoms of patients with aortoiliac occlusive disease may include claudication, rest pain of the lower extremities, or ischemic ulcer formation on lower extremities due to inadequate blood flow. However, patients may also be asymptomatic. An ankle-brachial index is the most widely used test to determine peripheral arterial disease initially. Aortofemoral bypass surgery has aided in the management of aortoiliac occlusive disease dating back to the early 1950s. More recently, revascularization with endovascular interventions has supplanted the aortofemoral bypass surgery as first-line therapy. However, in cases where endovascular techniques are unsuccessful or inappropriate, aortobifemoral bypass still plays an important role and can even be considered the gold standard for long term patency. This will discuss the relevant anatomy, indications, contraindications, as well as some important technique considerations.