title: Thoracic aortobifemoral bypass in treatment of juxtarenal Leriche syndrome (midterm results).
abstract: BACKGROUND
  The standard surgical treatment of infrarenal aortoiliac obstructive disease is abdominal aortobifemoral bypass (AABFB). However, alternative surgical procedures may be considered in cases of juxtarenal Leriche syndrome and previous aortofemoral graft obstruction. We present midterm results of 20 consecutive patients who underwent thoracic aortobifemoral bypass (TABFB) either as primary or secondary procedure.
  
  
  METHODS
  Between 1999 and 2010, 20 patients who were diagnosed to have juxtarenal Leriche syndrome (n = 17) and failure of previous AABFB graft (n = 3) were enrolled. The patients were classified according to the Rutherford classification. Mean follow-up period was 60.9 ± 38.3 months. Mean preoperative ankle-brachial index on the left lower extremity was 0.18 and on the right lower extremity was 0.20.
  
  
  RESULTS
  Seventeen patients with the diagnosis of juxtarenal Lercihe syndrome were primarily and three patients were secondarily (for treatment of failed previous AABFB graft) treated using TABFB procedure. The mean ankle-brachial index at last follow-up was 0.75 on the left lower extremity and 0.76 on the right. One-year patency rate was 100%, and 5-year patency rate was 94%.
  
  
  CONCLUSIONS
  TABFB precludes the risk of renal artery embolization in cases of juxtarenal obstruction, without adding any risk of morbidity and mortality. Its long-term patency is similar or even superior to conventional surgical bypass techniques. We propose its use as an initial treatment in juxtarenal Leriche syndrome as well as a remedial procedure in cases with previous AABFB graft occlusion.
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey. ckoksal@hotmail.com
authors.forename: Cengiz
authors.initials: C
authors.lastname: Koksal
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kocamaz
authors.forename: Eray
authors.initials: E
authors.lastname: Aksoy
authors.forename: Canturk
authors.initials: C
authors.lastname: Cakalagaoglu
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kara
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yanartas
authors.forename: Yasin
authors.initials: Y
authors.lastname: Ay
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007925:Leriche Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency