McCarthy W J, Rubin J R, Flinn W R, Williams L R, Bergan J J, Yao J S
Arch Surg. 1986 Jun;121(6):681-8. doi: 10.1001/archsurg.1986.01400060075010.
Descending thoracic aorta-to-femoral artery grafts were placed in 13 patients who had abdominal aortas deemed undesirable for surgical treatment. These included seven patients in whom an infected aortic graft had been removed for primary graft infection (three) or aortoduodenal fistula (four). These patients had been treated initially with axillary-femoral grafts. In five other patients, this approach was used following failure of at least two previous aortofemoral grafts. The remaining patient was so treated following multiple complex abdominal operations. The surgical technique involves a posterolateral, seventh interspace thoracoabdominal incision with a transdiaphragmatic retroperitoneal tunnel to the left groin. There was no operative mortality. The mean follow-up of all patients was 22 months (range, one to 44 months). All grafts remained patent except one, which was removed because of ascending groin infection. Three patients died, at 24, 29, and 44 months postoperatively, respectively. Reasonable perioperative morbidity and reliable patency make this an attractive technique for the conversion of axillofemoral bypasses and, when reentry of the abdominal cavity is undesirable, laparotomy is avoided.
对13例腹主动脉被认为不宜进行手术治疗的患者实施了降胸主动脉至股动脉移植术。其中包括7例患者，他们因原发性移植物感染（3例）或主动脉十二指肠瘘（4例）而移除了感染的主动脉移植物。这些患者最初接受了腋股动脉移植术治疗。另外5例患者在至少两次先前的主动脉股动脉移植术失败后采用了这种方法。其余1例患者在接受多次复杂腹部手术后接受了此治疗。手术技术包括经第七肋间后外侧胸腹联合切口，通过膈肌后腹膜隧道至左腹股沟。无手术死亡病例。所有患者的平均随访时间为22个月（范围为1至44个月）。除1例因腹股沟上行感染而移除的移植物外，所有移植物均保持通畅。3例患者分别在术后24、29和44个月死亡。合理的围手术期发病率和可靠的通畅率使这种技术成为腋股动脉旁路转换的一种有吸引力的方法，并且当不需要再次进入腹腔时，可以避免剖腹手术。
