76 - Aortobifemoral bypass grafting

Summary

Aortobifemoral bypass is performed in patients with atherosclerotic disease primarily involving the infrarenal aorta and iliac arteries. This typically causes claudication of the hip and buttock and may produce vasculogenic impotence in men in severe cases (called LeRiche syndrome). On examination, patients have diminished or absent femoral pulses and are frequently younger – 10 years younger on average – than the typical patient with symptomatic femoropopliteal disease.

Preoperative assessment usually includes contrast angiography, which may be performed via a brachial arterial approach if there are no palpable femoral pulses. Since aortobifemoral bypass is a physically stressful operation, an assessment of the patient's overall medical condition is imperative; some evaluation of cardiac function is frequently a part of this preoperative evaluation. If the patient's condition is not suitable for aortobifemoral bypass, other less invasive options that are not quite as durable may exist, including axillary-bifemoral bypass or endoluminal angioplasty.

The procedure requires a general anesthetic, a laparotomy incision, and bilateral groin incisions. After clamping the infrarenal aorta, a prosthetic graft is sewn onto the aorta proximally. The limbs of the graft are then tunneled in a retroperitoneal plane and sewn onto the femoral arteries. The procedure typically takes 2–4 hours and often requires packed red blood cell transfusion or the use of a cell saver autotransfusion system.

Usual postoperative course

Expected postoperative hospital stay

7 to 10 days.

Operative mortality

The operative mortality for aortobifemoral bypass is 1% to 3%.