Complex aortic revascularization

  • Viviana Manuel Hospital de Santa Maria, Centro Hospitalar Lisboa, Clínica Universitária de Cirugia Vascular, Lisboa, Portugal
  • Tony Soares
  • José Tiago
  • Pedro Martins
  • José Silva Nunes
  • Carlos Martins
  • José Fernandes e Fernandes

Abstract

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.

References

1. Brewster DC. Current controversies in the management of aortoiliac occlusive disease. J Vasc Surg. 1997;25:365-79.

2. Schneider JR, McDaniel MD, Walsh DB, et al. Axillofemoral bypass: Outcome and hemodynamic results in high-risk patients. J Vasc Surg. 1992;15:952-62, discussion 962-3.

3. Rutherford RB, Patt A, Pearce WH. Extra-anatomic bypass: A closer view. J Vasc Surg. 1987;6:437-46.

4. Marston WA, Risley GL, Criado E, et al. Management of failed and infected axillofemoral grafts. J Vasc Surg. 1994;20:357-65.

5. Passman MA, Farber MA, Criado E, et al. Descending thoracic aorta to iliofemoral artery bypass grafting: A role for primary revascularization for aortoiliac occlusive disease? J Vasc Surg. 1999;29:249-58.

6. Martins C, Rosa A, Evangelista A, et al. Revascularização dos membros inferiores a partir da aorta torácica descendente. Rev Port Cir Cardiotorac Vasc. 2004;11:91-6.

7. Martins C, Moura C, Almeida P, et al. Trombose da aorta terminal em doente portador de rim único fundido e localização pélvica (em panqueca). Primeiro caso da literatura. Rev Port Cir Cardiotorac Vasc. 2006;13:47-51.

8. Da Gama AD, Hilário C, Macedo M, et al. Procedimentos invulgares utilizados na cirurgia de reconstrução e/ou revascularização da aorta. Acta Med Port. 1992;5:187-93.

9. Barral X, Youvarlakis P, Boissier C, et al. Supraceliac aorta-to-lower extremity arterial bypass. Ann Vasc Surg. 1986;1:30-5.

10. Mills JL, Fujitani RM, Taylor SM. The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions. Am J Surg. 1991;162:638-42.

11. Cormier JM, Marzelle J, Albrand JJ, et al. Lower-limb revascularization from the supracoeliac aorta through a transcrural approach. Cardiovasc Surg. 1993;1:44---7.

12. Magnan PE, Ede B, Marchetti AA, et al. Results of lower limb revascularization from the descending thoracic aorta. Ann Vasc Surg. 2000;14:567---76.

13. Wolf YG, Sasson T, Wolf DG, et al. Thoracic aorta transobturator bipopliteal bypass as eventual durable reconstruction after removal of an infected aortofemoral graft. J Vasc Surg. 1997;26:693-6.

14. Jayaraj A, Starnes BW, Tran NT, et al. Thoracic aorta to popliteal artery bypass for bilateral lower-extremity critical limb ischemia. Ann Vasc Surg. 2012;26:858, e11-4.

15. Criado E, Keagy BA. Use of the descending thoracic aorta as an inflow source in aortoiliac reconstruction: Indications and long-term results. Ann Vasc Surg. 1994;8:38-47.
Published
2016-11-22
How to Cite
MANUEL, Viviana et al. Complex aortic revascularization. Angiologia e Cirurgia Vascular, [S.l.], v. 12, n. 3, p. 180-186, nov. 2016. ISSN 2183-0096. Available at: <http://acvjournal.com/index.php/acv/article/view/4>. Date accessed: 16 dec. 2017.
Section
Original Article

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.