Ascending aorta to bifemoral bypass—a ventral aorta

In the decade since April 1975 we accumulated a series of 18 patients with arterial conduits from the ascending aorta to the femoral arteries, 10 men aged 53 to 75 years (mean, 60 years) and eight women aged 33 to 56 years (mean, 50 years). In the first two patients, the conduit was placed subcutaneously; in the remaining 16 patients, it was placed behind the rectus muscle and in front of the posterior rectus fascia, thus following the ventral anastomotic axis of the internal mammary and inferior epigastric arteries. The conduit is not visible, palpable, or compressible in this position. This approach was usually chosen because of multiple failures of standard intra-abdominal and axillofemoral vascular reconstructions. Five patients had concurrent intramediastinal procedures, mostly coronary bypass or innominate artery repair. The early operations were performed with Dacron grafts with a bifurcation constructed just below the umbilicus. In the last nine patients, we have used an 8 or 10 mm polytetrafluoroethylene (PTFE) prosthesis and connected it to a 6 or 8 mm PTFE crossfemoral bypass. No operative deaths occurred. The 5-year patency rate by life-table analysis is 70%. This operation is an alternative to axillofemoral bypass in patients with an inoperable abdominal aortic aneurysm.