Implantation of the Distal Aorta: A Technique for Preservation of Pelvic Blood Flow in Aortofemoral Reconstruction

We report our initial experience with a previously undescribed variation of aortofemoral bypass. This technique is an alternative to end-to-side aortic anastomosis for preservation of pelvic blood flow. It Involves an end-to-end proximal aortic anastomosis with implantation of the distal aorta into the posterior wall of the bifurcation graft. This approach has been used selectively for nine patients. Seven patients operated on using this technique had bilateral external iliac artery disease preventing retrograde perfusion of the pelvis. We used this procedure in two other young patients to preserve large inferior mesenteric and distal aortic lumbar vessels proximal to common iliac artery occlusions. Mean follow-up has been 20 months. There have been no deaths and no major complications. This technique provides the hemodynamic benefit of a proximal end-to-end aortic anastomosis while maintaining patency of the distal aorta and its branches. Additional technical advantages may include better suture line protection from the duodenum and a decreased potential for graft limb kinking. These factors may ultimately result in superior long-term graft patency.