Extra-anatomic bypass for aortic obstruction below the renal arteries with bilateral iliac artery occlusion...

Aortoiliac occlusive disease (AIOD), or Leriche syndrome, results from progressive atherosclerotic narrowing of the infrarenal aorta and iliac arteries, causing claudication, diminished femoral pulses, and erectile dysfunction in men. While aortobifemoral bypass or endovascular repair are standard treatments, these may be unsuitable for patients with hostile abdominal anatomy or major comorbidities. In such cases, axillofemoral bypass offers an extra-anatomic alternative for limb salvage.

A 47-year-old male, heavy smoker with a prior aortofemoral bypass and chronic limb-threatening ischemia, presented with bilateral rest pain and right leg necrosis. Imaging revealed complete occlusion of the infrarenal aorta and both iliac arteries. Given hostile abdominal anatomy, reduced cardiac function (LVEF 40%), and prior surgeries, a staged axillobifemoral bypass was performed using a 7-mm ring-reinforced PTFE graft, along with an above-knee amputation of the necrotic limb. Postoperatively, femoral and pedal pulses were palpable, and duplex confirmed graft patency. At 6 months, the patient remained asymptomatic with sustained graft function.

Axillofemoral bypass, though less durable than anatomical bypass, is an effective option for high-risk AIOD patients when conventional revascularization is contraindicated. This case highlights its role in achieving limb salvage and symptom relief in complex vascular disease.