Aortofemoral bypass in the presence of total juxtarenal aortic occlusion.

Forty-two patients with total juxtarenal aortic occlusion were offered aortobifemoral bypass over a 6 year period. The majority presented with claudication and males predominated. In all patients, aortobifemoral bypass was successfully performed. The groins were initially explored and the aorta was then thrombectomised prior to the standard aortobifemoral bypass. Follow-up period ranged between 6 months and 5 years. There was a 4.8% perioperative mortality. Graft occlusion occurred in two patients in the immediate postoperative period, resulting in major amputation in one patient. Three patients developed graft occlusion during the period of follow-up, none of whom required amputation. Graft sepsis occurred in one patient and one patient developed a false aneurysm. We conclude that angiography cannot predict the feasibility of bypass in the presence of total aortic occlusion, and in our hands aortobifemoral bypass is feasible in all these patients. Early results are no different from the rest of the patients with aortoiliac disease.