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

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Severe coronary artery disease (CAD) and aortoiliac occlusive disease (AIOD) often present complex challenges, particularly in patients with small aorta syndrome.
• Simultaneous management of these conditions requires careful surgical planning and execution to ensure optimal patient outcomes.
• Small aorta syndrome, characterized by a hypoplastic infrarenal aorta, complicates standard bypass grafting procedures.

Observation:

• A 55-year-old male presented with angina pectoris and bilateral claudication.
• Diagnostic angiography revealed critical stenoses in coronary arteries, the left subclavian artery, and severe occlusive disease of the common iliac arteries, alongside a hypoplastic infrarenal aorta (9 mm diameter).
• The patient had severe coronary artery disease and aortoiliac occlusive disease with small aorta syndrome.

Findings:

• A successful simultaneous coronary artery bypass grafting and ascending aorta-bifemoral bypass was performed.
• Grafts utilized included an in-situ right internal mammary artery, autologous saphenous vein, and a Y-figured expanded polytetrafluoroethylene graft.
• Postoperative angiography confirmed the patency of all coronary and bifemoral artery grafts.

Implications:

• This combined surgical approach is a viable and effective treatment strategy for patients with concurrent severe coronary artery disease and aortoiliac occlusive disease.
• The procedure is particularly beneficial for patients with small aorta syndrome, offering a solution for complex multi-vessel disease.
• Successful simultaneous revascularization improves quality of life by alleviating symptoms of both cardiac ischemia and peripheral artery disease.