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DOI: 10.1055/s-0030-1269324
Usefulness of ascending to upper abdominal aortic bypass in the managenement of complex recurrent aortic isthmus stenosis
Objective: Recurrent stenosis of the aortic isthmus (ISTA) can be endowed with difficulties in local exposure due to multiple previous operations. In this report, we present our experience with complex recurrent ISTA treated with ascending to upper abdominal aortic bypass.
Patients and methods: Both patients presented with severe recurrent claudication of lower limbs: Patient 1 after having prosthetic replacement for ISTA at the age of 8 and 13 and patient 2 initially received patch plasties during childhood (6 and 9 years) which was followed by an ascending to descending aortic bypass at the age of 46 that showed high-grade stenosis of the distal anastomosis.
Results: We combined a median sternotomy with an upper median laparotomy and exposed the ascending aorta as well as the abdominal aorta at the supraceliac level. For perfusion of viscera and lower limbs during cross-clamping, we employed a heart-lung machine using femoro-femoral cannulation. In both cases, we used a 20mm Dacron graft that was directed from the supraceliac aorta through the diaphragm and pericardium lateral to the right atrium and anastomosed to the ascending aorta. The postoperative course of both patients was uneventful and postoperative as well as follow-up (12 months) imaging demonstrated patent grafts while both resumed full activity without clinical signs of claudication.
Conclusion: Ascending to upper abdominal aortic bypass can be employed as a useful method to restore lower body perfusion in patients with recurrent ISTA and complex anatomical situations.