title: Novel anastomotic method enables aortofemoral bypass for patients with porcelain aorta.
abstract: OBJECTIVE
  Porcelain aorta is an indication for axillofemoral bypass. However, the procedure has definitive flaws. We present a new method for achievement of aortofemoral bypass.
  
  
  METHODS
  The portion of the distal aorta for anastomosis is wrapped with a double polytetrafluoroethylene mesh and fixed to the adventitia with continuous sutures. The adventitia of the anastomotic site is cut over the mesh until the calcified surface is disclosed. Margins of the mesh and the peeled adventitia are fixed along the anastomotic margin with continuous sutures. After the aorta and distal arteries are occluded with balloon catheters, an opening on the bared calcification is made with an airdrill and enlarged with a laminectomy rongeur. The anastomosis is performed between a graft and the mesh-reinforced adventitia with continuous sutures. Over 6 years, this method has been applied to nine patients with porcelain aorta who are diabetic or undergoing dialysis. The indications were disabling claudication in three patients and limb salvage in six patients.
  
  
  RESULTS
  No anastomotic complications or operative deaths were seen, and satisfactory mid-term results were obtained, with follow-up ranging from 3 to 62 months after surgery. One patient died of coronary heart disease 3 years after surgery, but the grafts retained a good function.
  
  
  CONCLUSIONS
  This method is safe and effective, and more liberal application of this method may help improve outcome and quality of life.
authors.affiliation: Department of Surgery, Asahikawa Medical University, Midorigaoka-higashi 2-1, Asahikawa 078-8510, Japan. sasajit@asahikawa-med.ac.jp
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Sasajima
authors.forename: Masashi
authors.initials: M
authors.lastname: Inaba
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Azuma
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Akasaka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Asada
authors.forename: Hisashi
authors.initials: H
authors.lastname: Uchida
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sasajima
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Goh
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome