Thoracobifemoral bypass for radiation-induced paravisceral aortic stenosis

Abstract

Radiation-induced arterial disease is a delayed complication of childhood cancer therapy. We present the case of a 56-year-old man with disabling claudication secondary to severe paravisceral aortic stenosis, attributed to abdominal radiation for Wilms tumor in early childhood. Extensive periaortic fibrosis and calcification precluded endovascular repair and conventional aortobifemoral bypass. He underwent successful thoracobifemoral bypass via a left anterolateral thoracotomy approach and retroperitoneal tunneling of the graft. This case highlights the challenges of managing radiation-associated vascular disease. In select patients, thoracobifemoral bypass offers a durable solution when traditional approaches are contraindicated owing to hostile intraabdominal anatomy.

Keywords: Abdominal aortic occlusive disease; Aortobifemoral bypass; Extra-anatomical revascularization; Radiation-induced arteriopathy; Thoracobifemoral bypass.

Fig 1

Preoperative computed tomography angiography (CTA) demonstrating high-grade aortic stenosis in the (a) sagittal, (b) axial, and (c) coronal planes.

Fig 2

Axial computed tomography angiography (CTA) demonstrating the graft (yellow arrow) as it traverses the diaphragm and enters the retroperitoneal space (a), passes deep to the spleen (b), reaches the level of graft bifurcation (c), and courses subcutaneously toward the right groin (d).

Fig 3

Three-dimensional computed tomography reconstruction showing a thoracobifemoral bypass (TBF) graft originating from the descending thoracic aorta and extending to the bilateral common femoral arteries (CFAs).