Reducing morbidity of thoracoabdominal aneurysm repair by preliminary axillofemoral bypass

: Thoracoabdominal aneurysm (TAA) repair continues to be associated with appreciable morbidity and mortality. To reduce the substantial cardiac afterload of thoracic aortic clamping, preserve visceral, renal, and lower-extremity perfusion, and reduce spinal cord ischemia, a right axillofemoral bypass was performed before TAA resection. : Fifteen patients undergoing repair of their TAA had a preliminary axillofemoral bypass with an 8- to 10-mm externally supported polytetrafluoroethylene graft. Nine underwent elective repair and 6 were operated on emergently. All but 2 patients (both had type IV aneurysms) had spinal fluid drainage and all had moderate hypothermia induced (31°C to 32°C). All visible intercostal arteries were reimplanted. : Requirements for pharmacologic afterload reduction were minimal. Urine output was preserved during proximal aortic and intercostal anastomoses, and acidosis was minimal. Anticoagulation was not necessary unless the aortic bifurcation was replaced, and no patient had thrombotic complications. One (7%) patient died after repair of a ruptured aneurysm, and 1 (7%) developed paraplegia and required temporary dialysis. : Preliminary axillofemoral bypass avoids the profound hemodynamic and physiologic derangement caused by clamping of the thoracic aorta, and effectively reduces the morbidity of TAA repair.