Combination of Coronary Heart Disease and Critical Limb Ischemia: Evolution of Operation Technique

Evgeny Rosseykin, Andrey Voevodin, Vladlen Bazylev

Federal Center of Cardiovascular surgery, Penza, Russia

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

Often occurs ischemic heart disease among patients with critical ischemia of the lower extremities. In a cohort of patients suffering from coronary artery disease, atherosclerosis of the lower limbs is present in a third of cases approximately. Patients with lesions of both vascular regions are a difficult group for surgical treatment. Staged treatment carries a risk. There is problem of the choice of the conduit for coronary bypasses: internal mammary arteries are an important share of collateral blood delivery for limbs, use of veins of the legs in cases of critical limb ischemia is dangerous. We used the technique of a one-stage operation CABG and ascending aorta –bifemoral bypass.
Purpose of the study: to evaluate the results of one-stage surgical treatment.
Methods. We performed 22 operations of CABG and ascending aorta –bifemoral bypass. The first 20 procedures were performed with the placement of the aorto-femoral graft in the subcutaneous fat of the abdominal wall. We did not have major vascular problems, but there were frequent complications with wounds: seroma, lymphorrhea. Then we find a new, another graft's way. After changing the procedure, we did not have such complications.
Results. There are no cases of death, myocardial infarction, acute ischemia of the lower limbs. We had 6 (27%) cases of wound complications, all of these cases were obtained by placing the graft in the subcutaneous fat.
Conclusions: Ascending-bifemoral bypass and CABG is a positive method for such difficult cohort of patients. A new type of operation has some advantages and we hope will be very good alternative for old operation.