Combined coronary and femoral revascularization using an ascending aorta to bifemoral bypass

Combined Coronary Artery Bypass Grafting and Extra-anatomic Ascending Aorta to Bifemoral Grafting Through Median Sternotomy

A high proportion of patients with severe systemic atherosclerotic disease present with the involvement of both the coronary and aortoiliac arteries. For these patients with multiple comorbidities and high surgical risk, it is critical to minimize the overall physiologic burden of the operation when possible. Furthermore, with severe or complete occlusion of vascular supply to the lower extremities, it is beneficial to avoid two-stage surgeries because of the high risk of irreversible ischemia necessitating amputation. In select cases, a single combined operation without entering the abdominal cavity may be a reliable option. We present a case with excellent results using the technique of coronary artery bypass grafting (CABG) and extra-anatomic ascending aorta to bifemoral grafting through median sternotomy and subcutaneous tunneling. Furthermore, there is a wide variation in anticoagulation reversal practices among surgeons after performing these combined grafting operations. We administered only half of the ideal calculated protamine dose for reversal of heparinization, which achieved favorable results in our patient. Overall, with symptomatic occlusion of the coronary and aortoiliac arteries, combined CABG and extra-anatomic aortobifemoral grafting with subcutaneous tunneling is a reliable surgical option. The indication for this approach should be tailored to the anatomy of the lesion and the urgency of the clinical scenario.

Combined total arch replacement and bypass from the ascending aorta to the bilateral profunda femoris arteries

A 72-year-old woman who had aortic arch aneurysm was admitted. The patient was unable to walk without assistance because of aortoiliac occlusive disease. Total arch replacement and the ascending aorta to the bilateral profunda femoris artery bypass were performed during the same operation. On outpatient visits, the patient was able to walk with a cane and the ankle-brachial pressure index was markedly improved. This combined procedure is an option for patients with aortoiliac occlusive disease who are not candidates for alternate inflow procedures, especially when the patient has another indication for median sternotomy.

Combined coronary and femoral revascularization for the treatment of hypoplastic aortoiliac syndrome: report of a case

The coronary artery and aortoiliac occlusive disease frequently coexist and in relatively rare instances, a complication of hypoplastic aortoiliac syndrome (HAIS) may occur. We herein present our experience with a 51-year-old female patient with HAIS and concomitant coronary artery disease. She underwent a successful simultaneous coronary and femoral revascularization. The left anterior descending artery was bypassed with the in situ gastroepiploic artery and a biaorto-external iliac artery bypass was performed with expanded polytetrafluoroethylene precuffed grafts. She had a good postoperative course, with no angina or intermittent claudication. The importance of the technical aspects of reconstructive surgery in patients with HAIS has been emphasized in many reports in the literature, and the surgical options for combined coronary and femoral revascularization are also discussed herein.

Combined Coronary and Lower Extremity Revascularization with Thoracotomy: A Case Report

Patients with the combination of coronary artery disease and peripheral vascular disease have multiple risk factors and manifest widespread vascular disease. Although indications of combined coronary and femoral revascularization are rare, a combined procedure is useful in selected patients. We report a patient who underwent a successful combined coronary and lower extremity revascularization with anterolateral limited thoracotomy.

Simultaneous Off-Pump Coronary Artery Bypass Grafting and Ascending Aortobifemoral Bypass Graft via Ventral Abdominal Route

Aortoiliac disease often coexists with coronary artery disease. It is not uncommon to subject a patient to two separate interventions. We report two cases in which in simultaneous off-pump coronary artery bypass grafting was done with an ascending aortobifemoral bypass graft through the ventral abdominal route without any additional morbidity. Combining a technically simple method of limb bypass with an off-pump cardiac surgery is a promising procedure for revascularization of myocardium and lower limbs. We discuss the merits of combining an off-pump coronary artery bypass grafting procedure with a limb bypass.

Simultaneous Coronary Artery Bypass Grafting and Ascending Aorta to Bifemoral Bypass for Ischemic Heart Disease Combined with Critical Leg Ischemia: Case Reports

Coronary artery disease may coexist with aortoiliac occlusive disease, and concomitant revascularization procedures may be required. The ascending aorta may be used as the source of inflow to both the femoral and coronary arteries in patients who present with coronary artery disease and critical leg ischemia. We present here 2 patients in whom coronary artery bypass grafting and ascending aorta-to-bifemoral bypass operations were performed simultaneously.

Simultaneous coronary artery bypass grafting and ascending aorta bifemoral bypass in small aorta syndrome

A 55-year-old man with severe coronary artery disease and aortoiliac occlusive disease with small aorta syndrome was admitted to our department with angina pectoris and bilateral claudication. Intravenous subtraction angiography showed total occlusion of the right common iliac artery and 99% stenosis of the left common iliac artery with a markedly hypoplastic infrarenal aorta only 9 mm in diameter. It also revealed 90% stenosis at the origin of the left subclavian artery. Coronary angiography showed total occlusion of the left anterior descending artery and 90% stenosis of the circumflex artery. Simultaneous coronary artery bypass grafting and an ascending aorta-bifemoral bypass were conducted using an in-situ right internal mammary artery graft, an autologous saphenous vein graft, and a Y-figured expanded polytetrafluoroethylene graft. Postoperative angiography showed grafts to the coronary and bifemoral arteries were patient. This combined procedure is useful for patients with coronary artery disease and aortoiliac occlusive disease, especially in those with small aorta syndrome.

A rare case of arteriosclerosis obliterans without prominent risk factors complicated by idiopathic thrombocytopenic purpura. A case report

An eighty-four-year-old man was admitted to the hospital because of pain at rest in the lower extremities. On physical examination, trophic changes of the skin and petechiae in the limbs were observed. Computed tomographic scan of the abdomen showed focal renal infarctions and calcification of the descending aorta. Moreover, radionuclide imaging of the arterial system revealed complete obstructions of the two right iliac arteries and the left external iliac artery, where collateral flows were observed. Laboratory examination showed a severe thrombocytopenia caused by immunoglobulin G (IgG)-type autoantibody against platelets. He was diagnosed as having arteriosclerosis obliterans complicated by idiopathic thrombocytopenic purpura, although no known risk factors promoting atherosclerosis other than age were evident. In such a case with hemorrhagic diathesis, a hemorheologic agent and the vasodilator prostaglandin could confer advantages in relieving and controlling the ischemic leg pain without hemorrhagic complications. Moreover, small doses of the initial prednisolone therapy for ITP might also be recommended to avoid thrombus formations in the atherosclerotic lesions.