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Updated: Jun 18, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Coronary artery bypass grafting and concomitant descending aorta-to-bifemoral artery bypass via sternotomy
Kaya Suzer1, Omay Omay, Emre Ozker
1Department of Cardiovascular Surgery, Hizmet Hospital, Istanbul, Turkey.
Insights
This study presents a novel surgical technique combining coronary artery bypass grafting (CABG) with aorto-bifemoral bypass using the descending aorta. The procedure demonstrated excellent graft patency and a low complication rate in four patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Innovation
Background:
- Patients with combined coronary and aorto-iliac disease pose complex surgical challenges.
- Standard treatment often involves staged procedures, increasing patient risk.
- A novel approach using the descending aorta for inflow is evaluated.
Purpose of the Study:
- To assess the feasibility and efficacy of a combined coronary artery bypass grafting (CABG) and aorto-bifemoral bypass procedure.
- To evaluate the descending aorta as an inflow source for aorto-bifemoral bypass in conjunction with CABG.
- To determine the safety and patency rates of this combined surgical technique.
Main Methods:
- Four patients with advanced coronary and aorto-iliac disease underwent simultaneous CABG and aorto-bifemoral bypass.
- A bifurcated Dacron graft was anastomosed to the descending aorta via median sternotomy.
- Graft limbs were tunneled through the diaphragm and groin for distal anastomoses.
Main Results:
- All four patients experienced an uneventful postoperative recovery.
- Follow-up imaging (CT and MRA) at two years confirmed complete graft patency.
- The technique proved effective in managing complex combined arterial disease.
Conclusions:
- This combined surgical approach using the descending aorta is a reliable alternative for select CABG patients.
- The procedure offers a reasonable morbidity profile with excellent long-term graft patency.
- It provides a viable option for patients unsuitable for conventional aorto-femoral operations.
Introduction:
We evaluated a new approach of combined coronary and aorto-bifemoral artery bypass grafting performed through median sternotomy using the descending aorta as the inflow source.
Materials And Methods:
Four patients with advanced coronary and aorto-iliac disease were operated on in the same session. Following the coronary artery bypass grafting (CABG), we performed a proximal anastomosis of a bifurcated Dacron graft to the descending aorta through the posterior pericardium. The limbs of the graft were passed through the diaphragm into the retroperitoneal space. They were then passed through tunnels in the groins, and distal anastomoses in the groins were performed.
Results:
The postoperative course was uneventful in all four patients. In the second year, follow-up multi-slice computerised tomographies (CT) and magnetic resonance angiographies were done and all grafts were patent.
Discussion:
We believe this technique is a reliable alternative procedure to consider in CABG patients who are not suitable candidates for standard aorto-femoral operations. It has a reasonable rate of morbidity and perfect patency.
