Graft inclusion technique for thoracoabdominal aortic aneurysms involving visceral branches with the aid of a femoro-femoral bypass.

Eleven patients in our institution with thoracoabdominal aortic aneurysms involving the celiac, superior mesenteric and renal arteries underwent surgical treatment with the aid of a partial femoro-femoral bypass during the last three years. Three patients with expanding aneurysms underwent emergency operations. Another three patients with extensive aneurysms had two-stage operations: initial aortic arch or descending thoracic graft replacement followed by thoracoabdominal graft replacement in the second stage. Exposure of the aneurysms was made through a left transthoracic, retroperitoneal abdominal approach in all patients. The surgical technique employed in most cases in this series was graft inclusion with direct reattachment of the visceral vessels by anastomosis to an opening made in the graft. Pairs of intercostal and lumbar arteries between the levels of the ninth thoracic and fourth lumbar regions were reconstructed in a similar fashion on the basis of monitoring somatosensory evoked potentials. The operations were performed with the aid of a partial femoro-femoral bypass with selective celiac and renal arterial perfusion in most cases. All patients but one survived the operation and are leading normal lives late in the postoperative period. Graft inclusion with the aid of a partial bypass is a valid technique for the treatment of thoracoabdominal aortic aneurysms involving visceral branches.