Background: The standard surgical treatment of infrarenal aortoiliac obstructive disease is abdominal aortobifemoral bypass. However, alternative surgical procedures may be considered in cases of juxtarenal aortoiliac occlusion disease and re-do aortofemoral bypass (graft occlusion or infection).Method: Between January 2012 and January 2013, in Kasr El Aini hospital, 6 patients (5 males and one female) aged 51 - 65 years (mean 59 years), who were diagnosed to have juxtarenal Leriche syndrome. The patients were classified according to the Rutherford classification. The procedure entails the use of a single Dacron bifurcated graft from the descending thoracic aorta to the left femoral or external iliac artery then a femorofemoral crossover bypass to the right groin. Follow-up period was 3 - 6 months. Results: All patients treated using TABFB procedure. We had no mortality, and one case morbidity was encountered in the short term follow up period. Up to 12 months patency rate was 100%. Conclusion: TABFB precludes the risk of renal artery embolization in cases of juxtarenal aortoiliac occlusion, without adding any risk of morbidity and mortality. Patency rate was similar to conventional surgical bypass techniques. Although this series represents a small group of patients, we feel that descending thoracic aortofemoral bypass offers excellent inflow and patency for an initial treatment in juxtarenal aortoiliac occlusion.