A total of 87 patients underwent extraanatomical bypass procedures eabp which included 28 32% femoral procedures and 59 68% axillary procedures. Its expanded use has been described in a few other situations. The extraanatomic approach may reduce clamping time and therefore visceral, renal and peripheral ischemic complications. This article shows our initial attempts at surgical bypass extraanatomical vein to vein bypass as a means to alleviate the symptoms and salvage the use. Much of our discussion will focus on the more common lower extremity bypasses femorofemoral bypass and axillofemoral bypass. Cystogram in a patient with a detour extraanatomic stent permanent type for ureteric obstruction after sarcoma excision. The extraanatomic aortobifemoral bypass had been implanted 9 years previously due to a severe infection of an infrarenal aortic bifurcation prosthesis. One hundred fortyeight patients were evaluated for inflow revascularization and stratified by age, vascular anatomy, medical history, and cardiac functional class into aortic reconstruction ar, extraanatomic bypass eab, or iliac angioplasty based on a protocol that restricted ar to goodrisk. Extraanatomical bypasses should remain as alternative procedures because of their lower patency rates in comparison to anatomic procedures. From 1985 to 1999, a total of 19 children, aged 2 months to 18 years mean 10. No early or late complications occurred after the extraanatomic bypass movie. However, in patients with previous small size tube graft, an open surgical correction is mandatory and, in most cases, an anatomical aortic reconstruction is carried out. Operative procedures extraanatomic bypass procedures for further instructions. Extraanatomic aortic valve bypass or apicoaortic conduit has been adapted to selected high risk patients as an alternative to conventional aortic valve replacement and is based on the experimental work of alexis carrel.
Between 1996 and 2010, 15 extraanatomic bypass grafts of the aorta were performed in 14 patients. Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. Infected lower extremity extraanatomic bypass grafts. Extraanatomical arterial bypass of the aortoiliac segment. However, we have experienced prolonged chest drainage and have decided to investigate this complication and the morbidity related to this procedure. Simultaneous extraanatomic bypass and abdominal flag. A closer view, abstract the results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed.
Late results following extraanatomic bypass procedures for chronic aortoiliac occlusive disease. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra anatomic bypass procedures. Threedimensional images of extraanatomic arterial bypass. Extraanatomic urinary drainage for urinary obstruction. The use of apical suction devices has been well described for maintaining satisfactory haemodynamics during offpump surgical coronary revascularization. Extraanatomic urinary drainage for urinary obstruction 283 fig. Total prosthetic graft excision and extraanatomic bypass. The most common examples of extraanatomic bypass are axillofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass. Indications, techniques, and unique complications will all be covered. We present a single surgeon series of such procedures and determine relevant outcomes. Axillofemoral bypass grafts using polytetrafloethylene. These procedures offer a treatment strategy for patients in whom the risks of conventional anatomic bypasses make their use prohibitive. Pdf extraanatomic ascending aorta to abdominal aorta. We present a case with excellent results using the technique of coronary artery bypass grafting cabg and extraanatomic ascending aorta to bifemoral grafting through median sternotomy and subcutaneous tunneling.
Extraanatomic reconstruction can be staged before excision of the infected prosthetic graft, during the same operation or later, sometimes in a second oper ation if the degree of ischaemia permits. Extraanatomical bypass grafting is a recognised method of lower limb revascularisation in highrisk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. Here we report our experience of this procedure and its complications. Moreover, extraanatomic bypass may be associated with lower rates of graft reinfection.
While such procedures can be performed in any vascular bed, the term most frequently is used to describe those bypasses that reroute blood to the lower extremities, avoiding intracavitary procedures. During the followup period, the durability of the extraanatomic prosthetic graft was good and no reinfection of the graft developed. Eighty five percent of the patients had ischaemic pain at rest or skin necrosis. Use of apical suction to facilitate extraanatomic bypass.
Extraanatomic bypass graft from the ascending to the descending thoracic aorta represents a valuable option that avoids direct reintervention on the aortic arch or isthmus and can achieve excellent results with no residual gradient and minimal morbidity. A plugging stent graft may reduce endoleak of the residual aneurysm and contribute to aneurysmal regression. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extraanatomic bypass. Type a aortic dissection in a patient with congential. Indications the indications for extraanatomic bypasses are different according to the procedure contemplated acute or chronic unilateral or bilateral arterial occlusive disease mostly due to atherosclerosis whose disease is not amenable to endovascular treatment and in whom aortofemoral bypass. Total prosthetic graft excision and extraanatomic bypass core. Recurrent aortic narrowing after repair of aortic coarctation or interrupted aortic arch, as well as diffuse, longsegment aortic hypoplasia, can be difficult to manage. Reconstruc tion in patients eventually requiring graft excision n 25 entailed placement of a new prosthetic af or ap graft in eight, an autogenous ff graft in five, combined prosthetic af and autogenous ff bypass in two. We describe here a case of recurrent coarctation where an extraanatomic ascending to descending thoracic aorta bypass graft was.
Extraanatomic bypass has previously been described through left lateral thoracotomy from the descending thoracic aorta. Extraanatomic bypass from the ascending to the descending aorta was feasible and effective for extensive dissected aortic aneurysm in a patient with pulmonary comorbidity. In select cases, a single combined operation without entering the abdominal cavity may be a reliable option. Analysis of the pad patients who underwent on extraanatomic procedures same surgeon, same period 2. Complications of extraanatomic aortic bypass for complex. Bypass 0 qvarfordt 1984 9 endoarterectomy 22 cormier 1986 35 endoarterectomy bypass 8. Extraanatomic ascending aortadescending aorta bypass grafting through a sternotomy is an alternative approach for this problem. Transcatheter repair of combined ascending aortic pseudoaneurysm and aortic arch aneurysm through a cardiac transapical approach. Combined coronary artery bypass grafting and extra. Extraanatomic bypass grafting has been used as treatment for patients with. Extraanatomical venovenous surgical bypass for central.
Extraanatomic caroticosubclavian artery bypass technique is a relatively easy process in comparison to other techniques, and has better mortality and morbidity rates, because of that we prefer and recommend this technique as a first option for patients having sss. The term extraanatomic bypass implies deliberate avoidance of the natural anatomic pathway. Get a printable copy pdf file of the complete article 648k, or click on a page. The socalled extraanatomic bypasses are surgical arterial or venous bypass procedures that circumvent the normal anatomic pathways. The authors describe the operative technique approach and its postoperative course used in an adult patient with coarctation of aorta, in which it was not possible to perform the traditional correction with an endtoend anastomosis with graft. The choice of the type of material to be used to make the extraanatomic bypass ptfe or dacron. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extraanatomic bypass procedures. Indications for extraanatomic revascularization andrea gaggiano. Abstract little is known about the obstetrical management of patients with takayasu arteritis ta who have undergone extra. Eight days earlier, the patient had undergone surgical resection of an anastomotic aneurysm, with interposition of a short new graft segment at the right distal anastomosis of the bypass graft.
Conclusion an extraanatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic stenoocclusive disease in patients with type ii or iii ta, with favorable early and longterm outcomes. The extraanatomic bypass refers to any bypass graft that is placed outside of. Open surgical venoplasty in this group of patients is associated with a higher mortality and morbidity. Schaff, md e xcellent results for repair of aortic arch obstruction have been achieved in the majority of centers in the current era. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. Personal surgical education in the research field extraanatomic bypass operations 2. Rarely still, stent blockage may occur requiring change before 12 months. The term extraanatomic bypass implies delib erate avoidance of the natural anatomic pathway. The median patient age at surgery was 67 years range, 3694 years and the gender distribution revealed a predominance of males 67% to females 33%.
Other forms of extraanatomic bypass grafting, including obturator bypass and arch vessel bypass, are not addressed. Direct anatomic reconstruction for aortoiliac occlusive disease provides superior longterm graft patency and as a rule is preferable to extraanatomic bypass in patients with severe lower extremity ischemia. An additional femoropopliteal bypass procedure was carried out in patients with peripheral arterial disease that underwent extraanatomic bypass. In this chapter, we discuss the indications and techniques of the more commonly used extraanatomic bypass and also touch on more complex indications and uses in the endovascular era. Despite optimal blood pressure control, a mild aortic valve insufficiency worsened, and a second cardiac intervention with aortic valve replacement was needed when the patient turned 18 years old. The second edition of vascular surgery has been fully revised and updated to meet the needs of the vascular surgery trainee and provides practical advice on. Theoretically, the main disadvantage of this technique is the risk of bleeding due to the rupture of the aortic remnant. At last followup, 2 of 14 patients with extraanatomic bypass remained hyperten.
Extraanatomic bypass with openplugging stent graft for. Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. Since 1985, 19 patients aged 2 months to 18 years mean 10. Four patients developed complications related to persistent effusions leading to reinterventions, which led to mediastinitis in 2 instances. Extraanatomic bypass graft for recurrent aortic arch. Extraanatomic aortic bypass via sternotomy for complex. With this strategy, the coarctation figure 1d, blue arrows was bypassed and the. In complex aortic coarctation, extraanatomic bypass operation remains an effective procedure. The role of extraanatomic bypass in the surgical treatment of.
Extraanatomic left caroticosubclavian artery bypass. Extraanatomic bypass grafting has been used as treatment for patients with aortoiliac disease who were considered unfit for aortic surgery. Simultaneous extraanatomic bypass and abdominal flag flap for lower limb salvage in a patient with severe postbypass anastomotic groin infection. In the literature, we found several approach methods for repair aortic coarctation through extraanatomic bypass as follows. Personal experience in the use of extraanatomic bypass operations ebo.
532 1264 236 527 1601 1403 887 596 792 791 815 120 1348 783 658 698 832 897 900 927 357 835 531 1413 263 548 712 716 1417 1657 455 1617 1035 940 1050 265 1238 219 1484 675 104 999 199 593