Combined revascularization of coronary and femoral arteries, using the ascending aorta as inflow source

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Severe coronary artery disease (CAD) and peripheral artery disease (PAD), specifically leg ischaemia, often require complex surgical interventions.
• Combined revascularization addresses multi-vessel disease in both the coronary and peripheral arterial systems.
• Ascending aorta to bilateral femoral artery bypass and coronary artery bypass grafting (CABG) are established procedures for severe PAD and CAD, respectively.

Observation:

• A single patient presented with concurrent severe coronary artery disease and bilateral leg ischaemia.
• The patient underwent a combined surgical procedure to address both conditions simultaneously.
• The surgical strategy involved coronary artery bypass grafting (CABG) using vein grafts and femoropopliteal bypass using a Dacron graft.

Findings:

• Successful simultaneous revascularization of coronary and bilateral femoral arteries was achieved.
• Coronary arteries were bypassed using three vein grafts.
• Bilateral femoral arteries were bypassed with a Dacron graft, with the ascending aorta serving as the inflow source.

Implications:

• Combined revascularization is a viable and effective treatment for patients with severe, multi-site arterial disease.
• This approach can lead to significant symptom relief, improving quality of life and reducing the risk of amputation.
• Long-term follow-up demonstrated sustained patency of grafts and absence of angina and claudication, supporting the durability of the intervention.