Subclavian-femoral bypass grafting in treatment of lower-limb critical ischaemia in an elderly patient with an inoperable thoracoabdominal aortic aneurysm

Dzyundzya A.N., Shcherbyuk A.N.. Vinogradov O.A., Ulyanov D.A., Lysenko A.V., Dadashov S.A.
Department of Vascular Surgery University Clinical Hospital №1 State Educational Facility of Higher Professional Education «First Moscow State Medical, University named after I. M. Sechenov» Course of Emergency Surgery at the Surgery Chair of the Faculty of Advanced Medical Training, Moscow, Russia

The authors describe herein a variant of successful palliative treatment of a 73-year-old male patient suffering from an inoperable thoracoabdominal aortic aneurysm accompanied by coronary artery disease, painless myocardial ischaemia, pathological tortuosity of the left internal carotid artery, type 2 diabetes mellitus, and chronic renal insufficiency.

The patient was admitted to the Department of Vascular Surgery presenting with critical ischaemia of his left lower limb, complaining of numbness and gnawing pain both at rest and while walking a distance of up to 10-15 metres, demonstrating portions of skin ischaemia up to 2 cm long on the anterior surface of the femoral upper third, clinical signs of a thoracoabdominal aortic aneurysm, the presence of a pulsating formation in the projection of the infrarenal portion of the abdominal aorta measuring 5x6 cm.

The diagnosis was made based on the findings of instrumental examination, ultrasonography, multispiral computed tomographic angiography, and coronarography, having confirmed the following: a thoracoabdominal aortic aneurysm, occlusion of the left common artery and anterior iliac artery, coronary artery disease, painless myocardial ischaemia, pathological kinking of the left internal carotid artery, chronic renal insufficiency, and type 2 diabetes mellitus.

The first stage of the operation to perform consisted of mammary-coronary bypass grafting of the anterior interventricular artery from the left anterior lateral thoracotomy. Despite certain improvement in the condition of the coronary bed, the patient remained inoperable due to the presence of pronounced multiple-organ pathology and a high risk of lethal complications. Given these circumstances, the second stage of the intervention consisted in performing a palliative operation of subclavian-femoral bypass grafting on the left with a reinforced polytetrafluoroethylene stent graft.

KEY WORDS: thoracoabdominal aortic aneurysm, lower-limb critical ischaemia, surgical management.

P. 150

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