Thoracofemoral bypass: proximal exposure and tunneling.

Although axillobifemoral bypass is the usual alternative to the standard aortobifemoral bypass (ABF) when the latter is contraindicated because of comorbid operative risk or when the transabdominal approach is considered hazardous, a more proximal aortic inflow source is desirable in selected low-risk patients. The results with these more proximal aortic procedures are more durable than with axillobifemoral bypass and approach those that can be achieved with an ABF. This article reviews some of the specific technical details of descending thoracofemoral bypass, specifically, the techniques for proximal exposure and tunneling.