Complex aortic revascularization
Introduction: In the event of aortoiliac occlusive disease when revascularization from the infrarenal aorta is contraindicated, the axillary-femoral bypass surgery is the most common option, but it shows substantially inferior patency rates.
Material and methods: A retrospective analysis of six patients, submitted to surgery between 2003 and 2014, by the same surgical team, is presented.
Results: All six patients were male, their average age was 60.7 years (57-64 years) and they had multiple cardiovascular disease risk factors: arterial hypertention, smoking and dyslipidemia. At the time of the treatment, four patients had complaints of incapacitating intermitent claudication and two presented with critical limb ischaemia. All patients had contraindication to a revascularization procedure from the infrarenal aorta, particularly hostile abdomen, prosthetic infection and extensive calcification. Surgical treatment consisted in supraceliac aorta - bifemoral bypass in two patients and supraceliac aortic - bifemoral interposition on another patient; on the other three cases the influx was obtained from the descending thoracic aorta. The average follow-up is 6 years (9-1 years) and the grafts are functioning in excellent condition in 4 patients. One patient was lost to follow-up and the other died a year after surgery.
Conclusion: atencyevascularization procedures from the supraceliac or the descending thoracic aorta are an alternative in cases in which direct revascularization is contraindicated, with favorable morbi-mortality and long-term patency rates.