Extraanatomic bypass and coronary artery grafting for coral reef aorta

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Severe aortoiliac occlusive disease can lead to critical limb ischemia and abdominal angina.
• Coronary artery disease often coexists with peripheral artery disease, complicating treatment strategies.

Observation:

• A 63-year-old male presented with symptoms of abdominal angina and intermittent claudication.
• Multidimensional angiography revealed suprarenal aorta calcified obstruction, right external iliac artery occlusion, and in-stent restenosis of the right coronary artery.

Findings:

• An 8-mm bifurcated graft was used for extraanatomic bypass from the ascending aorta to the left external iliac and right femoral arteries.
• Concomitant off-pump coronary artery bypass grafting was performed.
• The patient experienced complete resolution of digestive symptoms and leg claudication post-procedure.

Implications:

• Extraanatomic bypass grafting is a viable option for complex aortoiliac disease when conventional bypass is not feasible.
• Simultaneous management of coronary and peripheral artery disease can yield significant clinical improvement.
• This case highlights the importance of a comprehensive surgical approach for multi-arterial disease.