A Case Report of a Combined Bypass Surgery on Coronary Artery and Right Common Femoral Artery of the Aorta (original) (raw)
Related papers
[Simultaneous coronary artery bypass grafting and the ascending aorta to bifemoral bypass]
PubMed, 2011
Objective: Coronary artery disease and arteriosclerosis obliterans (ASO) frequently coexist. Concomitant revascularization procedures may be required because harvest of the internal thoracic artery (ITA) in patients with ASO carries a risk of leg ischemia. This study reports our experience with combined coronary and femoral revascularization using the ascending aorta to bifemoral bypass. Patients: Seven male patients (including 4 high aortic occlusions) underwent concomitant aorto-femoral bypass and coronary revascularization between 1990 and 2007. Mean age was 66 years old. Results: Coronary artery bypass grafting (CABG) was performed on-pump in 5 cases and off-pump in 2 cases. The number of bypass grafts were 2.4 +/- 0.9. We harvested ITA in all cases. The prosthetic tube graft was positioned behind the muscles of the abnominal wall. One hospital death was related to mediastinitis. Perfect patency of the aorta-femoral grafts was obtained in all cases. Conclusions: The ascending aorta is a good source of inflow to femoral arteries and the ascending aorta to bifemoral bypass did not require an intraperitoneal procedure. Therefore the simultaneous operation can be performed in shorter time, and it is an interesting alternative in cases with ischemic heart disease and leg ischemia.
Simultaneous Coronary Bypass and Aorta- Right Common Carotid Artery Bypass Operation
2013
Coexistence of symptomatic coronary artery disease(CAD) and significant carotid artery stenosis(CAS) ranges from 3.4% to 22% . Although a simultaneous carotid endarterectomy and coronary artery bypass is generally accepted, there are discussions about the best approach. The difference in our case was the coexistence of coronary artery disease with internal carotid artery stenosis instead of a right common carotid artery stenosis, which was unsuitable for stenting. In this study, we report a simultaneous coronary artery bypass and an aortaright common carotis artery bypass operation with a synthetic graft in a patient with carotid artery disease and coronary artery disease.
American Journal of Case Reports, 2020
Unusual clinical course Background: An extra-anatomic bypass is the choice of revascularization method for limb salvage in patients with infra-renal aortailiac occlusion accompanied by severe comorbidities. Case Report: We report a case of aortailiac-occlusive disease in a 59-year-old man with severe cormobidities. He had complained about intermittent claudication in both lower limbs for the past 10 years. The condition had worsened over the last 5 months, making it difficult for him to walk. Three attempts had been made at percutaneous aortailiac stenting, all of which were unsuccessful. The patient had a history of coronary artery disease and complete revascularization by percutaneous coronary stenting 10 years ago. Extra-anatomic axillounifemoral bypass was performed under general anesthesia. The results were good, with improvement in the patient's distal perfusion immediately and at 1-month follow-up. Conclusions: After failed aortoiliac stenting, when direct revascularization aortofemoral bypass and endovascular intervention could not be carried out, extra-anatomic axillofemoral bypass was effective for revascularization in a patient with aortoiliac-occlusive disease and severe comorbidities.
Off-pump reduction aortoplasty and concomitant coronary artery bypass grafting
The Annals of Thoracic Surgery, 2004
and first diagonal branch as a hood with a 7-0 polypropylene. Each of these anastomoses was performed taking care to include all layers of the vessel to prevent further dissection. The proximal anastomosis was performed in an end to side fashion to the original left coronary ostium using a running 6-0 polypropylene (Fig 1d). All anastomoses were performed without tension and care was taken not to distort the Y-graft. Antegrade cardioplegia was delivered thru the aortic root to check for hemostasis of the anastomoses before closure of the pulmonary artery. Pulmonary artery continuity was restored using 4-0 polypropylene. As a precautionary measure, the left internal mammary (LIMA) was anastomosed to the apical LAD and a radial artery was anastomosed to the obtuse marginal. The patient was weaned easily from cardiopulmonary bypass and her postoperative course was uneventful. Comment Because of the rarity of CAA, treatment strategies and risks are not clearly defined. Complications can include thrombosis, embolization, dissection, and in rare cases rupture [1, 3]. The coronary artery surgery study (CASS) comprises the largest group of patients with CAA yet to be analyzed. Of the 20,087 patients evaluated by coronary angiography, 978 (4.9%) were found to have aneurysmal coronary artery disease. More than 50% of the patients with CAA had suffered a myocardial infarction prior to angiography, and more than 80% were found to have concomitant atherosclerotic coronary artery disease [1]. Although antiplatelet and anticoagulant therapy have been suggested, many patients will require surgery because of either associated atherosclerosis or complications of aneurysmal disease. Our patient presented with an acute coronary syndrome warranting surgical therapy. A variety of surgical strategies have been used in the past to treat CAA. The most common technique involves ligation of the aneurysm and distal bypass, which has been described for the treatment of left main coronary artery aneurysms [5]. In rare cases, aneurysmectomy followed by direct end-toend anastomosis has been performed [6], however, this procedure can rarely be performed without undue tension. An alternative approach has been to replace the aneurysmal segment with an interposition graft. Lepojarvi et al [7] reported arterial reconstruction of an aneurysm of the left main coronary artery, involving the LAD and circumflex arteries using a y-graft harvested from the internal iliac artery. Their result was excellent at 4 years. We also preferred to use an arterial interposition graft in this young patient. In contrast to the approach of Lepojarvi et al, we decided to use the lateral femoral circumflex artery. This conduit was selected because of its size, natural bifurcation and ease of procurement relative to an internal iliac dissection. We added LIMA and radial artery grafts due to the extent of proximal dissection, as well as a safeguard to early spasm in our arterial interposition graft. The patient has done well without symptoms after 24 months of follow-up. We believe that the lateral femoral circumflex artery serves as an excellent arterial interposition graft for aneurysms of the left main coronary artery involving the proximal circumflex and LAD.
Limb Ischemia Due to Use of Internal Thoracic Artery in Coronary Bypass
2010
Immediately after undergoing coronary bypass grafting using the left internal thoracic artery, a 59-year-old man developed left leg ischemia. Right-to-left femoral artery crossover bypass was performed and the ischemia resolved. A 72-year-old man developed left calf pain 12 days after a similar procedure; peripheral angiography revealed stenosis of the abdominal aorta and distal peripheral arteries, which did not require intervention.
Annals of Thoracic and Cardiovascular Surgery, 2013
Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).
Combined minimaly invasive surgery for coronary bypass and abdominal aortic occlusion
Cardiovascular Surgery, 2000
Association of extracorporal assisted coronary bypass with peripheral vascular surgery has already placecommon in the therapeutic arsenal. This case report presents a combined cardiac and vascular surgery in a high risk patient, with unstable angina following myocardial infarction and critical ischemia of a single lower limb. Synchronous minimally invasive direct coronary bypass graft and extra-anatomic aorto-profundal bypass in one single sitting were performed. The procedure was successful at 6 months follow up. We believe that this type of synchronous procedure, minimising surgical agression, could be effective in selected high risk patients.
Revista Portuguesa de Cardiologia, 2018
Introduction: Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is an infrequent finding. Revascularization is recommended in the presence of demonstrated viability or ischemia. Coronary artery bypass grafting (CABG) has long been considered the preferred option. Patients with previous CABG due to LMCA disease with occlusion of one graft and progression of the LMCA to CTO constitute a special population, as just one ischemic artery remains. For these patients, there is no other option for revascularization other than cardiac surgery (requiring resternotomy) or percutaneous coronary intervention (PCI) of the LMCA. Methods and Results: Out of 620 patients with CTO diagnosed in our center, we identified five with previous CABG due to LMCA disease for a retrospective case series. They had occlusion of one graft and progression of the LMCA to CTO. All five underwent PCI. Each patient received a functional classification for angina, myocardial ischemic tests, and a follow-up coronary angiogram during a median follow-up of 63 months. Coronary angiogram showed CTO of the semi-protected LMCA lesions with two CABGs previously performed in all patients, one occluded and the other patent. Three patients had occluded saphenous vein grafts to the circumflex coronary artery, and the rest had left internal mammary artery-left anterior descending artery CABG failure. Ischemia and viability were demonstrated. Surgery was ruled out due to high surgical risk. PCI due to CTO of the LMCA with drug-eluting stents was performed. In a five-year follow-up period, four patients remained asymptomatic and event free. One post-PCI death occurred from non-cardiovascular cause.
Extra Anatomic Aortic Bypass Graft for Coarctation of Aorta with associated Cardiac Lesion
IOSR Journals , 2019
Coarctation of the aorta in an adult patient with associated cardiac anomaly often needs extra-anatomic bypass techniques. Among various techniques, the posterior pericardial bypass technique is commonly used,in which a Dacron conduit is anastomosed between the lateral aspect of the ascending aorta or conduit and the descending thoracic aorta posterior to the pericardium. Multiple surgical techniques have been described for the surgical treatment of adult patients with paraductal coarctation of the aorta and associated cardiac anomaly. Multiple options are, staged procedure using left thoracotomy and median sternotomy, correction of coarctation via catheter based technique along with median sternotomy, and single-stage simultaneous repair of lesions via sternotomy. We are reporting six cases of ascending aorta to descending aorta bypass without laparotomy or thoracotomy. This approach helps us to avoid surgical dissection in vicinity to the multiple colleterals and inflamed lesion and left thoracotomy which also causes bleeding from the collaterals, and to allow concomitant cardiac procedures to be performed.
Transradial and Transfemoral Approach in Patients with Prior Coronary Artery Bypass Grafting
Journal of Clinical Medicine, 2020
The relationship between periprocedural complications and the type of vascular access in patients with prior history of coronary artery bypass grafting (CABG) and treated with percutaneous coronary interventions (PCIs) is less investigated than in the overall group of patients treated with PCI. The aim of the current study was to assess the relationship between the type of vascular access and selected periprocedural complications in a group of patients with prior history of CABG and treated with PCIs. Based on a Polish nationwide registry of interventional cardiology procedures called ORPKI, the authors analyzed 536,826 patients treated with PCI between 2014 and 2018. The authors extracted 32,225 cases with prior history of CABG. Then, patients with femoral and radial access as well as right and left radial access were compared. This comparison was proceeded by propensity score matching (PSM). After PSM, a multifactorial analysis revealed that patients treated with PCI from femoral ...