[Axillo-femoral bypass for adult form of extreme coarctation of the aorta--the long term prognosis].
A 33-year-old female with adult form of extreme coarctation underwent axillo-femoral bypass grafting. The postoperative hemodynamic improvement was remarkable. The patient spent excellent quality of life without any hypotensive drug or anticoagulant agent for 14 years until pseudoaneurysms of the bypass graft ruptured. The patient was saved by an emergency operation with 2 steps of surgical procedures. The first step was making the new axillo-femoral bypass at the contralateral side, then the diseased graft was replaced by a new graft as the second step. The postoperative catheterization revealed no pressure gradient between the upper and lower extremities, and the bilateral API's were over 100%. The pseudoaneurysm of the graft seemed to be caused by the stabbed needle holes for the dearing of the graft and the instrument for the partial occlusion of the graft. We learned from this experience that the needle holes of the graft should be repaired by plegeted sutures, and Fogarty clamp or the clamp with rubber sheath should be used for clamping graft. The axillo-femoral bypass is, of course, not a first choice procedure for extreme coarctation, but the hemodynamic improvement was achieved in our case. Therefore, it may be still useful for the compromised host as an alternative procedure to the radical correction.
Takagi
M
M
Department of Cardiovascular Surgery, Nagasaki University School of Medicine, Japan.
Fujii
T
T
Narimatsu
M
M
Hashiyada
H
H
Yamada
T
T
Kugimiya
T
T
D000328:Adult; D001017:Aortic Coarctation / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011475:Prosthesis Failure; D012086:Reoperation; D013348:Subclavian Artery / Q000601:surgery