Aortoiliac occlusive disease and gastrointestinal malignancy: changing therapeutic options

Treatment of gastrointestinal malignancy encountered unexpectedly during procedures involving the abdominal aorta continues to be debated. Previously, simultaneous vascular procedures with intra-abdominal malignancy were rare. Most underwent vascular reconstruction followed by a delayed aortic procedure. With recent improvement in axillobifemoral graft patency, a one-stage procedure for aortoiliac disease should be entertained. We recently encountered a small bowel lymphoma while beginning an aortic replacement for aortic occlusion. Resection of a near-obstructing small bowel tumor immediately after axillofemoral reconstruction provided treatment of both entities at one time. Since the early description of axillofemoral bypass in 1963, varying success with extra-anatomic bypass has been reported. Early data for axillofemoral bypass were dismal, but with recent technical and graft improvements patency has been improved. Occult malignancy during aortic procedures is uncommon, about 2 to 4 per cent, but when met is usually dealt with after the patient recovers from the vascular procedure. With improvements in extra-anatomic bypass results, a single operative period can be entertained.