Axillo-Bifemoral Artery Bypass for Atypical Coarctation.

Abstract

In 46-year-old man who had had general fatigue due to hypertension for about 20 years, only hypertension of the upper part of the body had been pointed out; the blood pressure of the upper limbs was 190mmHg and that of the lower limbs was 80mmHg. Computed tomography showed severe aortic stenosis with advanced calcification from the proximal descending thoracic aorta to the infra-renal abdominal aorta, the minimum caliber of the aorta being only 5mm. Hypertension was not controlled in spite of administration of 5 anti-hypertensive agents. Because renal factors were not related to hypertension, we chose a minimally invasive procedure: axillo-bifemoral artery bypass. After operation, the difference of blood pressure between upper and lower limbs reduced and symptoms disappeared. There are many case reports of aorto-aortic bypass for atypical coarctation, but we think that the less invasive axillo-bifemoral artery bypass is also an alternative procedure.

Successful Ascending Aorta-Abdominal Aorta Bypass Graft through the Left Thoracic Cavity in a Patient with Atypical Coarctation

“…1,2) Various surgical techniques can be used in adults with atypical coarctation of the aorta arising from the region of coarctation and its surroundings, including vascular prosthesis implantation, patch-angioplasty, aorto-aortic bypass, and axillo-bifemoral bypass. [3][4][5] The reason we selected ascending aorta-abdominal aorta bypass was because, despite it requiring a median sternotomy incision to the abdomen, we were able to use a large caliber vascular graft and thus expected to ensure a reliably alleviated afterload, long-term vascular graft patency, and satisfactory perfusion of the abdominal branching vessels. In addition, as we intended to perform pulmonary vein isolation for the atrial fibrillation, it was possible to obtain a good field of view of the ascending aorta and the expansion of the heart by midline sternotomy, and it was easy and safe to establish extracorporeal circulation.…”