The Role and Outcomes of Thoracodistal Bypass

Abstract

Objectives: Endovascular procedures for lower extremity revascularization are becoming more commonplace due to low morbidity, mortality, and shorter length of stay. The role of open bypass must be reconsidered. Aortobifemoral bypass is the gold standard for extensive aortoiliac occlusive disease (AIOD); however, thoracodistal bypass holds a niche position. We investigate indications and outcomes of thoracodistal bypass. Methods: Medical records of five patients who underwent thoracodistal bypass at Thomas Jefferson University Hospital (TJUH) between 2012 and 2019 were reviewed. Contemporary and historical literature was reviewed. Results: Indications included calcified paravisceral pathology, previous failed or infected bypass grafts, and prior abdominal operations. Thirty-day mortality at our institution was 0%. Four out of five patients had patent grafts at one year. Complications included pulmonary, renal, bleeding, and wound complications in addition to need for reintervention. Conclusions: Despite high complication rates associated with thoracodistal bypass, longterm patency and longterm survival rates are also high. Thoracodistal bypass continues to be a useful tool in select patients.