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Combined coronary artery bypass with descending thoracic aorta to bifemoral bypass grafting using minimal invasive
Apurva Shah1, Anil Sharma1, Sunil Dixit1
1Dept. of CTVS, SMS Medical College, Jaipur, Rajasthan India.
Insights
This case study shows that combining coronary artery bypass grafting (CABG) with thoraco-bifemoral bypass for peripheral vascular disease (PVD) using a thoracotomy approach is a viable option. This method may reduce surgical burden in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Coronary artery disease (CAD) and peripheral vascular disease (PVD) frequently coexist, particularly in aging populations with prevalent risk factors like smoking, diabetes, and obesity.
- Minimizing surgical burden is crucial in high-risk patients to prevent adverse outcomes and reduce morbidity.
- Traditional surgical approaches for combined CAD and PVD often involve median sternotomy.
Observation:
- A case of successful combined coronary artery bypass grafting (CABG) and thoraco-bifemoral bypass for PVD is presented.
- The surgery was performed using a left thoracotomy approach, deviating from the conventional median sternotomy.
- This approach was chosen to mitigate potential morbidity associated with sternotomy in an elderly patient.
Findings:
- The combined CABG and thoraco-bifemoral bypass via left thoracotomy proved to be a successful and reliable surgical strategy.
- The feasibility of this approach is dependent on the specific anatomical characteristics of the vascular lesions.
Implications:
- This case suggests that thoracotomy is a feasible alternative to median sternotomy for combined CABG and PVD surgery in select high-risk patients.
- This approach may offer a way to reduce surgical morbidity in elderly patients with complex cardiovascular and peripheral vascular disease.
- Further investigation into the anatomical considerations and patient selection for this combined thoracotomy approach is warranted.
Abstract:
Coronary artery disease (CAD) and peripheral vascular disease (PVD) often coexist and are prevalent due to population ageing, smoking, diabetes, unhealthy lifestyles, and the epidemic of obesity. In high-risk patients, it is critical to minimize the overall burden of surgery to avoid poor outcomes and morbidity. Here, we present a case of successful coronary artery bypass grafting (CABG) with thoraco-bifemoral bypass surgery for PVD via a left thoracotomy approach. Traditionally, median sternotomy is done for these kinds of surgeries. However, we preferred thoracotomy over sternotomy to avoid morbidity in old age. Our case suggests that combined CABG with thoraco-bifemoral bypass via thoracotomy approach is a reliable surgical option depending on the anatomy of the lesion.
