Chapter 84 - Aortobifemoral bypass grafting

Summary

Aortobifemoral bypass is performed in patients with atherosclerotic disease that primarily involves the infrarenal aorta and iliac arteries. This condition typically causes predictable, effort-related cramping and burning of the hip and buttock muscles, which is relieved with rest. Vasculogenic impotence (LeRiche syndrome) is also a possible comorbidity for men. On examination, patients with infrarenal aorta and iliac artery involvement 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. Alternatively, CTA (computed tomography angiography) and MRA (magnetic resonance angiography) are emerging as anatomically accurate, less invasive alternatives. Because 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 are available, including axillary-bifemoral bypass or endoluminal angioplasty and stenting.