Total exclusion technique for the management of abdominal aortic aneurysms.

A total exclusion and extraanatomic bypass method has been described for the treatment of abdominal aortic aneurysm. The technique is a one-stage procedure and consists of a right axillofemoral and femorofemoral bypass combined with ligation or plication of the inflow and outflow tracts of the abdominal aneurysm. Successful aneurysmal obliteration is demonstrable intraoperatively by simple palpation for the absence of pulsations. Our experience has affirmed this approach to be remarkably effective in 15 elderly, multiple-risk patients. There were no operative deaths, and morbidity had been low in this small series. The total exclusion technique presented compares favorably with all previously reported nonresective methods based on distal common iliac artery interruption, alone or in combination with injection of thrombotic agents. In particular, the problem of delayed aneurysmal rupture can be avoided with this technique. In view of the recently reported successful use of improved grafts in the axillofemoral position, we believe that the method just described can reliably be applied to high-risk, critically ill patients with abdominal aortic aneurysms.