Enfermedades cardiovasculares y diagnóstico

Axillofemoral Bypass for Critically Ischemic Lone Lower Limb: A Mercy Trial in a Final Exam or a Simple Remedy for an Impending Disaster?

Abstract

Abdulsalam Y. Taha

Critical limb ischemia with rest pain and/or tissue loss is a serious sequel of occlusive aortoiliac disease (AID) inevitably leading to amputation unless a timely successful revascularization is performed. The most effective therapy is aorto (bi) femoral bypass while endovascular intervention has an increasing role in lesions of favorable anatomy. However, there is a group of poor risk patients with co-morbidities who neither tolerate a major aortic surgery nor being suitable for endovascular therapy. For such patients, extra-anatomical bypass such as axillofemoral bypass, first used in 1963, emerges as an effective alternative. Herein, we describe the case of an Iraqi male, 65 year old with critically ischemic lone lower limb due to total occlusion of infra-renal aorta with a very poor distal runoff who underwent a successful axillofemoral bypass that relieved his pain and saved his single lower limb. The graft was patent 5 months following the operation as shown by Doppler ultrasonography (DUS) though longer follow up was not available. In conclusion, axillofemoral bypass is relatively a simple operation for a serious disease. Limb loss was inevitable in this patient without this ‟mercy trial ״. The alternative choice was either amputation or a major aortic surgery with a doubtful benefit and a definite morbidity.