Okada Syuichi, Tatsuo Kaneko, Obayashi Tamiyuki, Ezure Masahiko, Sato Yasufumi, Hasegawa Yutaka, Okonogi Shuichi, Tatsuishi Wataru, Date Kazuma, Tamura Tomoki
Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Kyobu Geka. 2011 Dec;64(13):1129-32; discussion 1132-4.
Coronary artery disease and arteriosclerosis obliterans (ASO) frequently coexist. Concomitant revascularization procedures may be required because harvest of the internal thoracic artery (ITA) in patients with ASO carries a risk of leg ischemia. This study reports our experience with combined coronary and femoral revascularization using the ascending aorta to bifemoral bypass.
Seven male patients (including 4 high aortic occlusions) underwent concomitant aorto-femoral bypass and coronary revascularization between 1990 and 2007. Mean age was 66 years old.
Coronary artery bypass grafting (CABG) was performed on-pump in 5 cases and off-pump in 2 cases. The number of bypass grafts were 2.4 +/- 0.9. We harvested ITA in all cases. The prosthetic tube graft was positioned behind the muscles of the abnominal wall. One hospital death was related to mediastinitis. Perfect patency of the aorta-femoral grafts was obtained in all cases.
The ascending aorta is a good source of inflow to femoral arteries and the ascending aorta to bifemoral bypass did not require an intraperitoneal procedure. Therefore the simultaneous operation can be performed in shorter time, and it is an interesting alternative in cases with ischemic heart disease and leg ischemia.
冠状动脉疾病与闭塞性动脉硬化症（ASO）常并存。由于ASO患者取用胸廓内动脉（ITA）存在腿部缺血风险，可能需要同时进行血运重建手术。本研究报告了我们使用升主动脉至双股动脉旁路移植术进行冠状动脉和股动脉联合血运重建的经验。
1990年至2007年间，7例男性患者（包括4例高位主动脉闭塞）接受了同期主动脉-股动脉旁路移植术和冠状动脉血运重建术。平均年龄为66岁。
5例行体外循环冠状动脉旁路移植术（CABG），2例行非体外循环CABG。旁路移植血管数量为2.4±0.9。所有病例均取用ITA。人工血管置于腹壁肌肉后方。1例医院死亡与纵隔炎有关。所有病例的主动脉-股动脉移植血管均保持完美通畅。
升主动脉是股动脉良好的流入源，升主动脉至双股动脉旁路移植术无需进行腹腔内操作。因此，同期手术可在更短时间内完成，对于合并缺血性心脏病和腿部缺血的病例是一种有吸引力的选择。
