Extended aortic bypass.
At the University of Alberta Hospital, six patients recently underwent placement of Dacron bypass grafts from the ascending aorta to the infrarenal abdominal aorta or femoral arteries for a variety of vascular problems. The operations were performed in patients with (1) multiple aortic coarctations, (2) congenital aortic arch interruption and congenital mitral stenosis, (3) recoarctation of the thoracic aorta after previous coaractation repair (two patients), (4) aortoiliac occlusive disease in a patient with multiple previous abdominal operations including an abdominal-perineal resection and left lower quadrant colostomy, and (5) idiopathic retroperitoneal fibrosis and multiple previous operations on the abdominal aorta. Surgical access was through midline sternotomy and laparotomy incisions, and groin incisions were used as required. Careful attention was paid to placing as much graft as possible in an extraperitoneal position. All patients survived the operation and had essentially uneventful postoperative courses with good results. This technique has previously been described. However, attention is drawn to it once again as an excellent means of bypassing the thoracic and abdominal aorta in selected patients with complex vascular problems.