[Simultaneous coronary artery bypass grafting and the ascending aorta to bifemoral bypass]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Context:

• Coronary artery disease and arteriosclerosis obliterans frequently coexist, necessitating complex revascularization strategies.
• Harvesting the internal thoracic artery for coronary artery bypass grafting in patients with arteriosclerosis obliterans poses a risk of leg ischemia.
• Combined procedures are often required, but traditional approaches may be limited by patient comorbidities.

Purpose:

• To evaluate the safety and efficacy of combined ascending aorta to bifemoral bypass and coronary revascularization.
• To assess the feasibility of using the ascending aorta as an inflow source for femoral bypass in patients requiring simultaneous coronary and lower extremity revascularization.
• To determine the outcomes of this combined approach in patients with ischemic heart disease and peripheral artery disease.

Summary:

• Seven male patients underwent combined ascending aorta to bifemoral bypass and coronary revascularization, with 4 having high aortic occlusions.
• Coronary artery bypass grafting was performed on-pump in 5 patients and off-pump in 2. Internal thoracic artery was harvested in all cases.
• Excellent patency of aorta-femoral grafts was achieved in all patients, with one hospital death due to mediastinitis.

Impact:

• The ascending aorta serves as a suitable inflow source for femoral bypass, enabling simultaneous revascularization without intraperitoneal procedures.
• This combined surgical approach can be performed in a shorter operative time.
• It presents a valuable alternative for patients suffering from both ischemic heart disease and leg ischemia, improving treatment options.