Simultaneous coronary bypass and extra-anatomical bypass from the ascending aorta to the deep femoral arteries in a high-risk patient with aortoiliac occlusive disease: A case report
Published 2019-10-15
Keywords
- aortoiliac occlusive disease,
- case report,
- extra-anatomical bypass
How to Cite
Copyright (c) 2019 Bayandin N. L., Tiurin M. Yu., Moiseev A. A.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Aortobifemoral bypass surgery is the ‘Gold standard’ of therapy in patients with aortoiliac occlusive disease. However, multifocal atherosclerosis, especially in combination with multivessel coronary artery disease and acute coronary syndrome in high-risk patients, continues to prove challenging for surgeons. Extra-anatomical methods or revascularization can be useful in these patients. As published reports of such cases are few, our case report would be of significant interest.
We describe the clinical case of 59-year old patient with aortoiliac occlusive disease, ischaemic heart disease, acute coronary syndrome, postinfarction cardiosclerosis and severe heart failure. The patient successfully underwent simultaneous coronary bypass and extra-anatomical bypass from the ascending aorta to the deep femoral arteries under parallel cardiopulmonary bypass.
We describe a method that enables simultaneous revascularization of the myocardium and lower extremities in high-risk patients while avoiding the abdominal part of the procedure. Such an extra-anatomical bypass from the ascending aorta to the femoral arteries may be an alternative to the conventional combination of aortocoronary and aortobifemoral bypass in such high-risk patients.
Received 5 May 2019. Revised 3 September 2019. Accepted 4 September 2019.
Funding: The study did not have sponsorship.
Conflict of interest: Authors declare no conflict of interest.
References
- Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G., Rutherford R.B.; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease. International Angiology. 2007;26(2):81-157. PMID: 17489079.
- Sharma G., Scully R.E., Shah S.K., Madenci A.L., Arnaoutakis D.J., Menard M.T., Ozaki C.K., Belkin M. Thirty-year trends in aortofemoral bypass for aortoiliac occlusive disease. Journal of Vascular Surgery. 2018;68(6):1796-804. PMID: 30001912. https://doi.org/10.1016/j.jvs.2018.01.067
- Aronow W.S., Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women ≥62 years of age. The American Journal of Cardiology. 1994;74(1):64-5. PMID: 8017309. https://doi.org/10.1016/0002-9149(94)90493-6
- Başbuğ H.S., Bitargil M., Karakurt A., Usta S., Özışık K. Critical lower limb ischemia in Leriche syndrome following acute myocardial infarction: limb salvage with an axillofemoral bypass. Cardiovascular Surgery and Interventions. 2015;2(2):43-6. https://doi.org/10.5606/e-cvsi.2015.373
- Ness J., Aronow W.S. Prevalence of coexistence of coronary artery disease, ischemic stroke, and peripheral arterial disease in older persons, mean age 80 years, in an academic hospital-based geriatrics practice. Journal of the American Geriatrics Society. 1999;47(10):1255-6. PMID: 10522961. https://doi.org/10.1111/j.1532-5415.1999.tb05208.x
- Lee T.H., Marcantonio E.R., Mangione C.M., Thomas E.J., Polanczyk C.A., Cook E.F., Sugarbaker D.J., Donaldson M.C., Poss R., Ho K.K., Ludwig L.E., Pedan A., Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043-9. PMID: 10477528. https://doi.org/10.1161/01.cir.100.10.1043
- Blaisdell F.W., Hall A.D. Axillary femoral artery bypass for lower extremity ischemia. Surgery. 1963;54(4):563-8. PMID: 14067216.
- Ligush J.J., Criado E., Burnham S.J., Johnson G. Jr., Keagy B.A. Management and outcome of chronic atherosclerotic infrarenal aortic occlusion. Journal of Vascular Surgery. 1996;24(3):394-405. PMID: 8808961.
- West C.A. Jr., Johnson L.W., Doucet L., Caldito G., Heldman M., Szarvas T., Speirs R.D., Carson S. A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta. Journal of Vascular Surgery. 2010;52(5):1164–72. PMID: 20732782. https://doi.org/10.1016/j.jvs.2010.05.112
- Baird R.J., Ropchan G.V., Oates T.K., Weisel R.D., Provan J.L. Ascending aorta to bifemoral bypass-a ventral aorta. Journal of Vascular Surgery. 1986;3(3):405-10. PMID: 3951026.
- Россейкин Е.В., Базылев В.В., Воеводин А.Б. Показания для асцендо-бифеморального шутирования. Ангиология и сосудистая хирургия. 2018;24(4):133-44. Режим доступа: http://www.angiolsurgery.org/magazine/2018/4/18.htm [Rosseikin E.V., Bazylev V.V., Voevodin A.B. Indications for ascending aorta-bifemoral bypass grafting in patients with ihd and occlusion of the infrarenal aorta. 2018;24(4):133-44. (In Russ.) Available from: http://www.angiolsurgery.org/en/magazine/2018/4/18.htm]
- Schneider J.R., McDaniel M.D., Walsh D.B., Zwolak R.M., Cronenwett J.L. Axillofemoral bypass: outcome and hemodynamic results in high-risk patients. Journal of Vascular Surgery. 1992;15(6):952-63. PMID: 1597893.