Thoracic aorta to popliteal artery bypass for bilateral lower-extremity critical limb ischemia.
Thoracic aortic to infrainguinal arterial bypasses are rare in the literature, even more so when the outflow is the popliteal artery bilaterally. The case of a patient presenting with critical limb ischemia, chronic infrarenal aortic occlusion, and recurrent thrombosis of a unilateral axillobifemoral graft managed with thoracoretroperitoneal bitransobturator bipopliteal bypass is presented. The patient's vascular history was significant for multiple previous groin procedures for thrombectomy of her axillobifemoral graft, aortomesenteric bypass, redo aortomesenteric bypass for graft thrombosis, and multiple bowel resection procedures for acute mesenteric ischemia. The thoracic aorta and popliteal arteries were selected as sites for proximal and distal anastomoses, respectively, given anticipated difficulty in exposing the supraceliac aorta and femoral arteries. The technique of this operative approach is discussed.
Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, USA. arjun@u.washington.edu
Arjun
A
Jayaraj
Benjamin W
BW
Starnes
Nam T
NT
Tran
Thomas
T
Hatsukami
D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D012086:Reoperation; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome