Combination of Coronary Heart Disease and Critical Limb Ischemia: Evolution of Operation Technique
- #AC/COM 01-O-4
- Adult Cardiac Surgery/Comorbidity. SESSION-1
- Oral
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.