title: Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction.
abstract: BACKGROUND
  The standard surgical treatment of coarctation of the aorta is through a left posterolateral thoracotomy. However, when a concomitant cardiac procedure is required or the conventional approach is not possible or is hazardous, extraanatomic bypass to the supraceliac abdominal aorta may be advantageous. We discuss our technique and report the long-term results.
  
  
  METHODS
  Between January 1986 and January 2015, 25 patients (16 males, 9 females) underwent extraanatomic bypass to the supraceliac abdominal aorta for various lesions of the arch and the descending thoracic aorta. Extraanatomic bypass to the supraceliac abdominal aorta was performed for patients in whom balloon dilatation was not feasible due to associated arch hypoplasia (n = 9), long-segment thoracic aorta narrowing due to nonspecific aortoarteritis (n = 3), or isolated long-segment coarctation of the aorta (n = 3). Patients who needed concomitant cardiac procedures, such as aortic valve replacement (n = 4), ascending aortic aneurysm repair (n = 2), or coronary artery bypass grafting (n = 1), and in whom balloon dilatation had failed, also underwent extraanatomic bypass to the supraceliac abdominal aorta. Extraanatomic bypass was also performed in 3 patients with recurrent coarctation after surgical repair and in whom balloon dilation was not feasible or unsuccessful.
  
  
  RESULTS
  There were no early or late deaths. The peak-to-peak gradients between the upper limb and the lower limb decreased from 59.3 ± 16.3 mm Hg to 2.0 ± 2.8 mm Hg (p < 0.0001). The mean follow-up was 96.6 ± 92.6 months (range, 1 to 240 months; median, 54 months). Doppler interrogation of the lower limb arterial system after a mean follow-up of 86.4 ± 85.2 months showed an unobstructed flow pattern. The ankle-brachial pressure index improved from a preoperative value of 0.60 ± 0.07 to 1.04 ± 0.11 (p < 0.0001). Systolic blood pressure decreased significantly compared with preoperative values (153.9 ± 18.9 vs 122.8 ± 10.2, p < 0.0001). Three patients continued to receive antihypertensive medication due to persistent mild hypertension.
  
  
  CONCLUSIONS
  Extraanatomic bypass to the supraceliac abdominal aorta provides effective palliation for complex aortic obstructions. It is easy and quick to perform, avoids fatal complications, and is well tolerated in all age groups.
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Manikala Vinod
authors: MV
authors: Kumar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: shivchoudhary@hotmail.com.
authors: Shiv Kumar
authors: SK
authors: Choudhary
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Sachin
authors: S
authors: Talwar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Parag
authors: P
authors: Gharde
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Manoj
authors: M
authors: Sahu
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Sanjeev
authors: S
authors: Kumar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Dinesh
authors: D
authors: Chandra
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Rachit
authors: R
authors: Saxena
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Lokender
authors: L
authors: Kumar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Balram
authors: B
authors: Airan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000601:surgery; D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002445:Celiac Artery / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult