Moreover, extraanatomic bypass may be associated with lower rates of graft reinfection. 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. 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. A total of 87 patients underwent extraanatomical bypass procedures eabp which included 28 32% femoral procedures and 59 68% axillary procedures. At last followup, 2 of 14 patients with extraanatomic bypass remained hyperten. Personal experience in the use of extraanatomic bypass operations ebo. A closer view, abstract the results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. Reverse extraanatomic aortic arch debranching procedure. Type a aortic dissection in a patient with congential. We describe here a case of recurrent coarctation where an extraanatomic ascending to descending thoracic aorta bypass graft was. Operative procedures extraanatomic bypass procedures for further instructions. However, we have experienced prolonged chest drainage and have decided to investigate this complication and the morbidity related to this procedure. The use of apical suction devices has been well described for maintaining satisfactory haemodynamics during offpump surgical coronary revascularization. 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.
In select cases, a single combined operation without entering the abdominal cavity may be a reliable option. Extraanatomical arterial bypass of the aortoiliac segment. 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. 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. Four patients developed complications related to persistent effusions leading to reinterventions, which led to mediastinitis in 2 instances. Extraanatomic bypass grafting has been used as treatment for patients with. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extraanatomic bypass procedures. Total prosthetic graft excision and extraanatomic bypass. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extraanatomic bypass.
Get a printable copy pdf file of the complete article 648k, or click on a page. The extraanatomic approach may reduce clamping time and therefore visceral, renal and peripheral ischemic complications. Indications for extraanatomic revascularization andrea gaggiano. Between 1996 and 2010, 15 extraanatomic bypass grafts of the aorta were performed in 14 patients. 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. 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.
Here we report our experience of this procedure and its complications. Threedimensional images of extraanatomic arterial bypass. In complex aortic coarctation, extraanatomic bypass operation remains an effective procedure. Late results following extraanatomic bypass procedures for chronic aortoiliac occlusive disease. Complications of extraanatomic aortic bypass for complex. From 1985 to 1999, a total of 19 children, aged 2 months to 18 years mean 10. 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. Theoretically, the main disadvantage of this technique is the risk of bleeding due to the rupture of the aortic remnant. The most common examples of extraanatomic bypass are axillofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass. Combined coronary artery bypass grafting and extra. Personal surgical education in the research field extraanatomic bypass operations 2. Rarely still, stent blockage may occur requiring change before 12 months. Recurrent aortic narrowing after repair of aortic coarctation or interrupted aortic arch, as well as diffuse, longsegment aortic hypoplasia, can be difficult to manage.
The socalled extraanatomic bypasses are surgical arterial or venous bypass procedures that circumvent the normal anatomic pathways. Infected lower extremity extraanatomic bypass grafts. In the literature, we found several approach methods for repair aortic coarctation through extraanatomic bypass as follows. 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. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. Extraanatomic bypass grafting has been used as treatment for patients with aortoiliac disease who were considered unfit for aortic surgery. We present a single surgeon series of such procedures and determine relevant outcomes.
Open surgical venoplasty in this group of patients is associated with a higher mortality and morbidity. Use of apical suction to facilitate extraanatomic bypass. Much of our discussion will focus on the more common lower extremity bypasses femorofemoral bypass and axillofemoral bypass. Extraanatomic bypass has previously been described through left lateral thoracotomy from the descending thoracic aorta. Extraanatomic ascending aortadescending aorta bypass grafting through a sternotomy is an alternative approach for this problem. We have adopted the extraanatomic bypass graft as the procedure of choice for the treatment of coarctation and aortic arch hypoplasia in the adultsized patient. Extraanatomic bypass graft for recurrent aortic arch obstruction sameh m. These procedures offer a treatment strategy for patients in whom the risks of conventional anatomic bypasses make their use prohibitive. Schaff, md e xcellent results for repair of aortic arch obstruction have been achieved in the majority of centers in the current era. 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%.
An additional femoropopliteal bypass procedure was carried out in patients with peripheral arterial disease that underwent extraanatomic bypass. Eighty five percent of the patients had ischaemic pain at rest or skin necrosis. 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. 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. With this strategy, the coarctation figure 1d, blue arrows was bypassed and the.
Extraanatomic urinary drainage for urinary obstruction. 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. Extraanatomic bypass graft for recurrent aortic arch. 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. Pdf extraanatomic ascending aorta to abdominal aorta.
Analysis of the pad patients who underwent on extraanatomic procedures same surgeon, same period 2. The term extraanatomic bypass implies delib erate avoidance of the natural anatomic pathway. 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. 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. Extraanatomic aortic bypass via sternotomy for complex. Simultaneous extraanatomic bypass and abdominal flag. Total prosthetic graft excision and extraanatomic bypass core. Bypass 0 qvarfordt 1984 9 endoarterectomy 22 cormier 1986 35 endoarterectomy bypass 8.
Since 1985, 19 patients aged 2 months to 18 years mean 10. 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. Request pdf extraanatomic bypass the socalled extraanatomic bypasses are surgical arterial or venous bypass procedures that circumvent the normal anatomic pathways. Other forms of extraanatomic bypass grafting, including obturator bypass and arch vessel bypass, are not addressed. The choice of the type of material to be used to make the extraanatomic bypass ptfe or dacron. A plugging stent graft may reduce endoleak of the residual aneurysm and contribute to aneurysmal regression. Extraanatomic bypass from the ascending to the descending aorta was feasible and effective for extensive dissected aortic aneurysm in a patient with pulmonary comorbidity. Extraanatomical venovenous surgical bypass for central. The most common examples of extraanatomic bypass are axiuofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass.
Transcatheter repair of combined ascending aortic pseudoaneurysm and aortic arch aneurysm through a cardiac transapical approach. The extraanatomic aortobifemoral bypass had been implanted 9 years previously due to a severe infection of an infrarenal aortic bifurcation prosthesis. The extraanatomic bypass refers to any bypass graft that is placed outside of. Extraanatomic bypass with openplugging stent graft for. Extraanatomic urinary drainage for urinary obstruction 283 fig. No early or late complications occurred after the extraanatomic bypass movie. Axillofemoral bypass grafts using polytetrafloethylene. During the followup period, the durability of the extraanatomic prosthetic graft was good and no reinfection of the graft developed. 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. The role of extraanatomic bypass in the surgical treatment of.
Simultaneous extraanatomic bypass and abdominal flag flap for lower limb salvage in a patient with severe postbypass anastomotic groin infection. 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. Cystogram in a patient with a detour extraanatomic stent permanent type for ureteric obstruction after sarcoma excision. Extraanatomic left caroticosubclavian artery bypass.
The term extraanatomic bypass implies deliberate avoidance of the natural anatomic pathway. 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. Its expanded use has been described in a few other situations. Of 1 procedures in this group, extraanatomic bypass of the brachiocephalic vessels.
Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. 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. Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. Looking for online definition of extraanatomic bypass in the medical dictionary. Extraanatomical bypasses should remain as alternative procedures because of their lower patency rates in comparison to anatomic procedures.
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