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Combined coronary and femoral revascularization using an ascending aorta to bifemoral bypass
V A Jebara1, J N Fabiani, C Acar
1Department of Cardiovascular Surgery, Hôpital Broussais, Paris, France.
Insights
Ascending aorta to bifemoral bypass is a viable option for patients with coexisting coronary artery disease and severe leg ischemia. This technique offers advantages like ease of performance and reduced hospital stay.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease and aortoiliac disease often occur together.
- Simultaneous revascularization may be necessary in select patients.
- Ascending aorta to bifemoral bypass is a less common surgical approach.
Purpose of the Study:
- To report the experience with ascending aorta to bifemoral bypass in patients requiring simultaneous coronary and aortoiliac revascularization.
- To evaluate the safety and efficacy of this surgical technique.
Main Methods:
- Prospective consecutive sample study design.
- Ten male patients underwent concomitant aortoiliac and coronary revascularization.
- Ascending aorta served as the inflow source to the femoral arteries.
Main Results:
- One hospital death occurred, unrelated to the surgical procedure.
- All surviving patients recovered uneventfully and remained asymptomatic.
- Follow-up confirmed the absence of coronary or peripheral vascular disease symptoms.
- Echo-Doppler studies demonstrated excellent patency of the aorto-femoral grafts.
Conclusions:
- Ascending aorta to bifemoral bypass is a valuable alternative for selected patients with severe coronary and leg ischemia.
- Advantages include ease of performance, non-intraperitoneal approach, graft protection, direct inflow from the ascending aorta, and shorter hospital stays.
Objective:
Coronary artery and aortoiliac disease frequently coexist. In rare instances simultaneous procedures may be required. This study reports our experience with ascending aorta to bifemoral bypass.
Design:
Prospective consecutive sample study.
Patients:
Ten male patients who underwent concomitant aortoiliac and coronary revascularization with the ascending aorta as the source of inflow to the femoral arteries between 1989 and 1991.
Results:
One hospital death was unrelated to the surgical technique. All survivors displayed an uneventful recovery and were free of symptoms. Follow-up was obtained in all nine cases, they all stayed asymptomatic in terms of coronary artery disease and peripheral vascular disease. Echo-doppler studies showed perfect patency of the aorto-femoral grafts in all cases.
Conclusions:
This study shows that the ascending aorta to bifemoral bypass constitutes an interesting alternative in selected cases mainly those with severe ischemia coronary and leg ischemia. It offers the following advantages: (1) it is easy to perform, (2) does not require an intraperitoneal procedure, (3) the graft's position behind the muscles of the abdominal wall is not compressible, (4) the ascending aorta is the source of inflow, and (5) it allows a shorter duration of hospital stay.