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Hentgen B, Davaine J, Jayet J, Verscheure D, Couture T, Koskas F. Extra anatomic aorto-iliac revascularization using descending thoracic aorta to bifemoral bypass in selected cases. Ann Vasc Surg 2022; 86:210-218. [DOI: 10.1016/j.avsg.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022]
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Al-Musawi M, Dugan MM, Ohanisian L, Rubay D, Abed AN. Combined Coronary Artery Bypass Grafting and Extra-anatomic Ascending Aorta to Bifemoral Grafting Through Median Sternotomy. Cureus 2019; 11:e6077. [PMID: 31853428 PMCID: PMC6894900 DOI: 10.7759/cureus.6077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
| | - Michelle M Dugan
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Levonti Ohanisian
- Orthopaedic Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - David Rubay
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Ali N Abed
- Cardiac Surgery, Iraqi Center for Heart Diseases/Medical City Teaching Complex, Baghdad, IRQ
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Abreu R, Castro JM, Valentim H, Laranjeira Á, Rodrigues H, Rodrigues G, Quintas A, Camacho N, Gonçalves FB, Castro JA, Ferreira ME, Fragata J, Capitão LM. Revascularização dos membros inferiores a partir da aorta ascendente – caso clínico. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Takashima N, Hayakawa M, Hosoba S, Kinoshita T, Kuroyanagi S, Nota H, Suzuki T, Asai T. Combined total arch replacement and bypass from the ascending aorta to the bilateral profunda femoris arteries. Ann Vasc Dis 2014; 7:183-6. [PMID: 24995068 DOI: 10.3400/avd.cr.13-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 04/01/2014] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Noriyuki Takashima
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masato Hayakawa
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Soh Hosoba
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takeshi Kinoshita
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Satoshi Kuroyanagi
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiromitsu Nota
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tohru Asai
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Moharana M, Agarwal S, Pratap H, Singh A, Tamagond S, Satsangi DK. Efficacy and safety of beating heart coronary revascularization coupled with ascending aorta-bifemoral grafting: Analysis of short term results. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-010-0002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ito H, Yamamoto K, Hiraiwa T. Combined coronary and femoral revascularization for the treatment of hypoplastic aortoiliac syndrome: report of a case. Surg Today 2008; 38:1120-3. [PMID: 19039639 DOI: 10.1007/s00595-007-3753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 11/28/2007] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Hisato Ito
- Division of Cardiovascular Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan
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Goksel OS, Ugurlucan M, Alpagut U, Tireli E, Dayıoglu E. Concomitant Coronary and Peripheral Arterial Disease: Single-Stage Revascularization. J Card Surg 2008; 23:246-7. [DOI: 10.1111/j.1540-8191.2008.00591.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tarhan IA, Yilmaz M, Arslan IY, Kehlibar T, Ozler A. Combined Coronary and Lower Extremity Revascularization with Thoracotomy: A Case Report. Heart Surg Forum 2007; 10:E168-9. [PMID: 17597045 DOI: 10.1532/hsf98.20061204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Ibrahim Arif Tarhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Rajendran S, Prabhu AD, Thazhakuni I, Vellachamy KA, Vettath MP. Simultaneous Off-Pump Coronary Artery Bypass Grafting and Ascending Aortobifemoral Bypass Graft via Ventral Abdominal Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007. [DOI: 10.1177/155698450700200207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sunil Rajendran
- MIMS Institute of Cardiac Sciences, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - Anil Damodara Prabhu
- MIMS Institute of Cardiac Sciences, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - Ismail Thazhakuni
- MIMS Institute of Cardiac Sciences, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
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Simultaneous Off-Pump Coronary Artery Bypass Grafting and Ascending Aortobifemoral Bypass Graft via Ventral Abdominal Route. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007; 2:84-5. [DOI: 10.1097/imi.0b013e318054e6f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Selimoglu O, Yildirim T, Basaran M, Us MH, Ogus NT. Simultaneous Coronary Artery Bypass Grafting and Ascending Aorta to Bifemoral Bypass for Ischemic Heart Disease Combined with Critical Leg Ischemia: Case Reports. Heart Surg Forum 2006; 9:E820-2. [PMID: 16893756 DOI: 10.1532/hdf98.20061088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Ozer Selimoglu
- Cardiovascular Surgery Service, Goztepe, Safak Hospital, Istanbul, Turkey
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Matsuzaki K, Seino R, Yasuda K. Simultaneous coronary artery bypass grafting and ascending aorta bifemoral bypass in small aorta syndrome. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:398-400. [PMID: 10935336 DOI: 10.1007/bf03218166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
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.
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Affiliation(s)
- K Matsuzaki
- Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Hokkaido, Japan
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Yamagishi S, Ohta M, Segawa C, Abe T, Sawada T. A rare case of arteriosclerosis obliterans without prominent risk factors complicated by idiopathic thrombocytopenic purpura. A case report. Angiology 1996; 47:413-7. [PMID: 8619516 DOI: 10.1177/000331979604700414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- S Yamagishi
- Department of Internal Medicine, Kanazawa Municipal Hospital, Kanazawa, Japan
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