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Descending thoracic aorto-bifemoral bypass graft: a safe alternative in the high risk patients
D P O'Brien1, R P Waldron, J P McCabe
1University College Hospital, Galway.
Insights
A patient with abdominal aortic occlusion developed pancreatitis after a translumbar aortogram. A Descending Thoracic Aorta Bifemoral bypass successfully treated the occlusion, avoiding prosthetic infection.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- A 59-year-old male presented with severe intermittent claudication.
- Imaging revealed total occlusion of the abdominal aorta distal to the renal arteries.
Observation:
- The patient developed acute pancreatitis and a pancreatic abscess post-translumbar aortogram.
- This necessitated open surgical drainage of the abscess.
Findings:
- Re-vascularization was achieved after 15 months via a Descending Thoracic Aorta Bifemoral (DTAB) bypass.
- This surgical approach avoided prosthetic material in a potentially contaminated surgical field.
Implications:
- Delayed re-vascularization can be a viable strategy in complex cases.
- Minimizing prosthetic use in infected fields is crucial for patient outcomes.
- This case highlights potential complications of translumbar aortography.
Abstract:
A fifty-nine year old male presented with disabling intermittent claudication. A Translumbar Aortogram was performed showing ".....total occlusion of the abdominal aorta just distal to the level of the renal arteries". As a direct result of this invasive radiological procedure, he subsequently developed acute pancreatitis and a pancreatic abscess necessitating open surgical drainage. Re-vascularisation of his aortic occlusion was deferred for fifteen months when a Descending Thoracic Aorta Bifemoral (DTAB) bypass was performed--thus avoiding the insertion of foreign, sterile, arterial prosthesis in a previously infect abdominal cavity.