Simultaneous coronary bypass and extra-anatomical bypass from the ascending aorta to the deep femoral arteries in a high-risk patient with aortoiliac occlusive disease: a case report

Aortobifemoral bypass surgery is the 'Gold standard' of therapy in patients with aortoiliac occlusive disease. However, multifocal atherosclerosis, especially in combination with multivessel coronary artery disease and acute coronary syndrome in high-risk patients, continues to prove challenging for surgeons. Extra-anatomical methods or revascularization can be useful in these patients. As published reports of such cases are few, our case report would be of significant interest. We describe the clinical case of 59-year old patient with aortoiliac occlusive disease, ischaemic heart disease, acute coronary syndrome, postinfarction cardiosclerosis and severe heart failure. The patient successfully underwent simultaneous coronary bypass and extra-anatomical bypass from the ascending aorta to the deep femoral arteries under parallel cardiopulmonary bypass. We describe a method that enables simultaneous revascularization of the myocardium and lower extremities in high-risk patients while avoiding the abdominal part of the procedure. Such an extra-anatomical bypass from the ascending aorta to the femoral arteries may be an alternative to the conventional combination of aortocoronary and aortobifemoral bypass in such high-risk patients.