Technique and Long-Term Results of Laparoscopic Aorto-Bi-Femoral Bypass for Juxta-Renal Aortic Occlusion

Background: Describe the technique and the long-term results of total laparoscopic aorto-bifemoral bypass for juxtarenal aortic occlusion (JRAO).

Methods: From December 2000 to January 2023, 16 patients with a JRAO (TASC D lesions) underwent total laparoscopic aorto-bifemoral bypass. The patients' database was prospective and the file analysis was retrospective.

Results: Median age was 61 years (33-79). Ten patients had debilitating intermittent claudication, and 6 patients had severe critical ischemia. All patients were operated on through a laparoscopic left retrorenal approach. One conversion to open surgery was performed. Median operative time was 315 min (240-470). Median total aortic clamping time was 97.5 min (53-140). Median suprarenal aortic clamping time was 16 min (4-23). No hospital mortality nor severe systemic complications occurred. We observed variations in renal function during hospitalization and during the follow-up. However, no patients required early or long-term dialysis. Median follow-up was 116 months (1-213). Two patients developed bilateral femoral pseudoaneurysms (43rd and 186th months). No patient developed false aortic aneurysm. An aortobifemoral bypass was occluded on an antiphospholipid syndrome (151st month). Eight patients died during the follow-up.

Conclusions: This series shows that total laparoscopic aortic approach of JRAO is feasible and safe in good surgical risk patients. It represents an additional approach of JRAO at the era of complex endovascular procedures.