The socalled extraanatomic bypasses are surgical arterial or venous bypass procedures that circumvent the normal anatomic pathways. From the department of surgery, tulane university school of. The proposition is to present some real cases and their operational plan with emphasis for extra anatomic bypass and its principles and pitfalls. 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. Extraanatomic bypass to the distal profunda femoris. The extraanatomic bypass was done by exposing the descending aorta through the posterior pericardium and placing the graft around the left margin of the heart. Read extraanatomic revascularization for preoperative cerebral malperfusion due to distal carotid artery occlusion in acute type a aortic dissection, european journal of cardiothoracic surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. A plugging stent graft may reduce endoleak of the residual aneurysm and contribute to aneurysmal regression. We describe here a case of recurrent coarctation where an extraanatomic ascending to descending thoracic aorta bypass graft was. M c foster, t mikulin, b r hopkinson, and g s makin. In the literature, we found several approach methods for repair aortic coarctation through extraanatomic bypass as follows. Here in, we present a case of delayed paralysis developed after an extraanatomic axillarybifemoral bypass of infected thoracic aorta in a 51. Use of apical suction to facilitate extraanatomic bypass. Extraanatomic bypass with openplugging stent graft for.
An overview and update of femorofemoral crossover bypass. Get a printable copy pdf file of the complete article 257k, or click on a. We usually perform an extra anatomical bypass if possible, but in our cases this approach is not available because the anostomosis included the major abdominal branches. We usually perform an extraanatomical bypass if possible, but in our cases this approach is not available because the anostomosis included the major abdominal branches. Extraanatomic bypass of the abdominal aorta was performed in 25 patients too ill to undergo abdominal operation group i and in 22 patients with graft sepsis or hemorrhage group ii.
The role of extraanatomic bypass in the surgical treatment of. Personal experience in the use of extraanatomic bypass operations ebo. Extraanatomic bypass from the ascending to the descending aorta was feasible and effective for extensive dissected aortic aneurysm in a patient with pulmonary comorbidity. Extraanatomic bypass has previously been described through left lateral thoracotomy from the descending thoracic aorta. We describe here a case of recurrent coarctation where an extra anatomic ascending to descending thoracic aorta bypass graft was constructed using cardiopulmonary bypass without. Get a printable copy pdf file of the complete article. A suprahepatic to innominate vein conduit was used to provide hepatic venous egress. Intermittent claudication vanderbilt university medical. We present the case of a 48yearold woman with recurrent aortic coarctation and systemic hypertension with systolic value around 190200 mmhg and preoperative systolic pressure gradient 70 mmhg, submitted to an extraanatomical bypass.
Extraanatomic bypass grafting has been used as treatment for patients with aortoiliac disease who were considered unfit for aortic surgery. Personal surgical education in the research field extra anatomic bypass operations 2. 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. Aortobifemoral bypass aortoiliac bypass femoralfemoral bypass extraanatomic bypass axillofemoral, etc. Aortic root aneurysm in an adult patient with aortic coarctation. Feb 26, 2016 read extra anatomic revascularization for preoperative cerebral malperfusion due to distal carotid artery occlusion in acute type a aortic dissection, european journal of cardiothoracic surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The term extra anatomic bypass implies delib erate avoidance of the natural anatomic pathway. We preferred the courses of the grafts depending on this point of view. Its expanded use has been described in a few other situations.
Extraanatomic revascularization for preoperative cerebral. Operative view of the extra anatomic aortic bypass. Analysis of the pad patients who underwent on extra anatomic procedures same surgeon, same period 2. In the case of severe infections or injured tissue in the groin or small pelvis caused by trauma, prior operations or radiation therapy, a transiliac bypass is a simple and safe alternative. Surgical management of acute aortic infection is challenging, including excision of the infected segment and reconstruction either through extra anatomical bypass or in situ graft replacement with higher risk of reinfection.
We describe treatment of a latepresenting aef due to a thoracic aneurysm with an extraanatomic bypass graft for the aortic repair. Request pdf extraanatomic bypass the socalled extraanatomic bypasses are surgical arterial or venous bypass procedures that circumvent the normal anatomic pathways. Extra anatomic 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. Use of apical suction to facilitate extraanatomic bypass for. The most common examples of extraanatomic bypass are axillofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass. In ten patients, extraanatomic saphenous vein bypass grafts to the splanchnic vessels were constructed and inflow was obtained from the external iliac artery. Surgical management of acute aortic infection is challenging, including excision of the infected segment and reconstruction either through extraanatomical bypass or in situ graft replacement with higher risk of reinfection. Here in, we present a case of delayed paralysis developed after an extra anatomic axillarybifemoral bypass of infected thoracic aorta in a 51 year old caucasian male. Since then, this technique was modified by powell, who routed. The graft has remained patent during the 12month period of observation. Extraanatomic bypass graft for recurrent aortic arch obstruction sameh m. Eighty five percent of the patients had ischaemic pain at rest or skin necrosis. The purpose of this abstract is to address surgical strategies to manage aortic coarctation in adults in case of inadequate anatomic profile.
Ascendingthoracoabdominalabdominal extra anatomical bypass has been previously described in cases, mostly for obstructive thoracic aortic, with high durability and adequate blood flow to the mesentery and lower extremities. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extraanatomic bypass. Aortic root aneurysm in an adult patient with aortic. The arrow shows the extra anatomic bypass using the great saphenous vein to the distal profunda femoris artery. Personal surgical education in the research field extraanatomic bypass operations 2. Autologous vein conduits based on bypass location, length, and availability of suitable native conduits.
Extra anatomic bypass grafting has been used as treatment for patients with aortoiliac disease who were considered unfit for aortic surgery. Simplified splanchnic artery revascularization using extra. Extraanatomic bypass definition of extraanatomic bypass. Ct scan showed the patency of the extra anatomic bypass. Pantaloon femoral vein graft as neoaorta in infected. Extra anatomic bypass of the abdominal aorta was performed in 25 patients too ill to undergo abdominal operation group i and in 22 patients with graft sepsis or hemorrhage group ii. Indications the indications for extra anatomic 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 would be high risk procedure femerofemoral. Looking for online definition of extra anatomic bypass in the medical dictionary. Operative procedures extraanatomic bypass procedures for further instructions. However, severe instent stenoses occurred during followup and the girl developed acute renal failure.
Undoubtly, the most common types of extraanatomic bypass are axillofemoral, axillobife moral and femorofemoral bypass. Although only a few successful cases have been reported in the literature, most describe an in situ repair. 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%. Infected lower extremity extraanatomic bypass grafts. If unsuccessful, contralateral axillofemoral or femorofemoral grafts are indicated to reestablish blood flow. Through a median sternotomy, an extraanatomical bypass from ascending to descending aorta was performed. Get a printable copy pdf file of the complete article 648k, or click on a page. Single artery bypass of an occluded right coronary artery. Ct scan control of the aortic extra anatomic bypass. From 1985 to 1999, a total of 19 children, aged 2 months to 18 years mean 10. Extraanatomic pulmonary artery bypass for main pulmonary artery stenosis caused by neoplasm by ryo aeba, hiroaki nomori and ryohei yozu download pdf 214 kb. Operative techniques in thoracic and cardiovascular surgery. The graft patency rate determined by life table analysis in group i patients was 83. Infected abdominal aortic disease and graft infections pose a significant challenge for the vascular surgeon.
Extra anatomic bypass from the ascending to the descending aorta was feasible and effective for extensive dissected aortic aneurysm in a patient with pulmonary comorbidity. Extraanatomic bypass graft for recurrent aortic arch obstruction. Extra anatomic bypass coursing through the right margin of the heart is preferred versus the graft leading around the left margin because it prohibits the risks of resternotomy as the graft is hidden away from the sternum. Clowes, md \sb\a long synthetic graft polytetrafluoroethylene was used to provide an extra anatomic bypass of an iliac vein obstruction secondary to recurrent thrombophlebitis. 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. Extraanatomic bypass with openplugging stent graft for extensive dissected aortic aneurysm yoshiaki saito, md, ryosuke kowatari, md, masahito minakawa, md, phd, kazuyuki daitoku, md, phd, yasuyuki suzuki, md, phd, and ikuo fukuda, md, phd, aomori, japan treatment for an extensively dissected aortic aneurysm is a surgical challenge. Aug 12, 2014 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. Anatomic intrathoracic aortic bypass conduits in the management of coarctation of the aorta, journal of cardiac surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Extraanatomic bypass for recurrent abdominal aortic and. We present a single surgeon series of such procedures and determine relevant outcomes. Total prosthetic graft excision and extraanatomic bypass core. The arrow shows the extraanatomic bypass using the great saphenous vein to the distal profunda femoris artery.
Extra anatomic bypass graft for recurrent aortic arch obstruction. 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. Extraanatomical bypasses are surgical procedures performed at sites that do not correspond to the natural anatomy. Full text full text is available as a scanned copy of the original print version. Personal experience in the use of extra anatomic bypass operations ebo. All patients were preoperatively assessed with angiograms conventional, computed tomography, or magnetic resonance angiography and doppler ultrasonography. Aortic graft complicated by a corynebacterium striatum. What is the abbreviation for extra anatomic bypass. Extraanatomic pulmonary artery bypass for main pulmonary. Extraanatomic bypass to the distal profunda femoris artery. The main objective of extraanatomical bypass is to simplify a large surgical procedure, such as aortofemoral reconstruction, allowing a higher number of patients to be revascularized. We describe treatment of a latepresenting aef due to a thoracic aneurysm with an extra anatomic bypass graft for the aortic repair. The most common examples of extra anatomic bypass are axiuofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass.
A closer view, abstract the results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extraanatomic bypass grafting, is known to be a suitable treatment. Extra anatomic bypass has previously been described through left lateral thoracotomy from the descending thoracic aorta. The role of endovascular repair by stent grafts is being increasingly described but is limited to relatively less virulent. In ten patients, extraanatomic saphenous vein bypass grafts to the splanchnic vessels were constructed and inflow was obtained from the. In addition, this allows thorough debridement of the infected aortic lesions. Detail of the proximal anastomosis c arrow between the left common femoral artery and the great saphenous vein. Healing was achieved by performing a new extraanatomic bypass transosseously through the iliac wing with secondary explantation of the infected grafts. The proximal anastomosis was made to the left aspect of the ascending aorta1. Jun 01, 2010 extra anatomical 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. A highway or section of a highway that passes around an obstructed or congested area.
Extraanatomic bypass grafting has been used as treatment for patients with. Open surgery was performed with two extraanatomic bypasses, a thoracictoabdominal aortic bypass and a left iliactorenal bypass, on an urgent basis. Implant technique considerations continued use a beveled anastomosis to accommodate the difference in diameters cut across the renal arteries. We present a case of hepatic venous baffle obstruction in left atrial isomerism and dextrocardia in which surgical revision was complicated by atrial size discrepancy and portal hypertensionrelated varices. We performed extraanatomic bypass grafting after endovascular embolization successfully in two patients.
Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extraanatomic bypass and femoropopliteal bypass and were performed on an emergency basis. Aortofemoral bypass definition of aortofemoral bypass by. 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. Transcatheter repair of combined ascending aortic pseudoaneurysm and aortic arch aneurysm through a cardiac transapical approach. Open surgery was performed with two extra anatomic bypasses, a thoracictoabdominal aortic bypass and a left iliactorenal bypass, on an urgent basis. Reversal of paralysis and visceral ischemia after thoracic. 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. Extraanatomical arterial bypass of the aortoiliac segment. The proposition is to present some real cases and their operational plan with emphasis for extraanatomic bypass and its principles and pitfalls. Extraanatomical bypasses should remain as alternative procedures because of their lower patency rates in comparison to anatomic procedures. Thrombectomy is the treatment of choice for occluded extraanatomic bypass grafts. The tube is tunnelled around the right heart border.
Extra anatomical bypass of iliac vein obstruction use of a synthetic expanded polytetrafluoroethylene goretex graft alexander w. 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. Revascularization of the superior mesenteric artery or renal artery is frequently complicated by concomitant atherosclerotic disease in the adjacent aorta. Extra anatomic bypass with openplugging stent graft for extensive dissected aortic aneurysm yoshiaki saito, md, ryosuke kowatari, md, masahito minakawa, md, phd, kazuyuki daitoku, md, phd, yasuyuki suzuki, md, phd, and ikuo fukuda, md, phd, aomori, japan treatment for an extensively dissected aortic aneurysm is a surgical challenge.
This management is technically complex and carries a reported early mortality rate of 24% to 45% 17. The term extraanatomic bypass implies deliberate avoidance of the natural anatomic pathway. Anatomic intrathoracic aortic bypass conduits in the management of coarctation of the aorta, journal of cardiac surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Extraanatomic bypass grafting for aortoesophageal fistula. Code description sizing length ai aortoiliac suprarenal to a minimum of 4 cm distal to the iliac bifurcation. The term extraanatomic bypass implies delib erate avoidance of the natural anatomic pathway.
Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. Thinwall and impra flex thinwall grafts are not recommended for these types of bypass procedures. Analysis of the pad patients who underwent on extraanatomic procedures same surgeon, same period 2. Singlestage repair of a critical aortic coarctation, a. A total of 87 patients underwent extraanatomical bypass procedures eabp which included 28 32% femoral procedures and 59 68% axillary procedures. Extraanatomical ascendingthoracoabdominal bypass for. 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 suprahepatic to innominate vein conduit in. One hundred and three femorofemoral ff grafts, 40 axillounifemoral and 12 axillobifemoral grafts were performed. However, there was no change in collateral arteries figure 2. Reverse extraanatomic aortic arch debranching procedure. Ascendingthoracoabdominalabdominal extraanatomical bypass has been previously described in cases, mostly for obstructive thoracic aortic, with high durability and adequate blood flow to the mesentery and lower extremities.
Much of our discussion will focus on the more common lower extremity bypasses femorofemoral bypass and axillofemoral bypass. Extraanatomical bypass grafting a single surgeons experience. Extraanatomic bypass article about extraanatomic bypass. The use of apical suction devices has been well described for maintaining satisfactory haemodynamics during offpump surgical coronary revascularization. Extraanatomic bypass graft for recurrent aortic arch. The most common examples of extraanatomic bypass are axiuofemoral and femorofemoral bypasses and their combination, the socalled axillobifemoral bypass. The patient underwent bilateral axillofemoral bypass. Request pdf an overview and update of femorofemoral crossover bypass surgery as an extraanatomic bypass procedure femorofemoral crossover.
1539 1047 1536 598 595 1057 805 716 174 1007 236 584 1428 74 234 54 975 1430 23 1337 1393 1135 537 737 933 1425 71 733 1179 1188 136 681 543 1230 887 599 363 535 454 127 1044 870 1436 1458 1291