Femoral Axillary Bypass: An Alternative Approach to Occlusive Disease of the Aortic Arch Vessels in High-Risk Patients

Abstract

Although axillo-femoral bypass grafts have proven to be an effective alternative to the usual anatomic reconstructions for peripheral vascular insufficiency, there are only a few scattered case reports of the reversed flow, femoro-axillary bypass for treatment of the potentially more serious condi tions of cerebral ischemia associated with occlusive disease of the major aortic arch branches. This unique alternative approach becomes particularly compelling in the high-risk patient with occlusive lesions of all the aortic arch vessels. Although theoretically feasible, the effectiveness, practicality, safety, and long-term patency of this approach remain to be proven.

The case of a 59-year-old woman with cerebral ischemia secondary to occlusive disease of all aortic arch branches treated by femoro-axillary bypass is presented, and some of the observations of previous case reports are reviewed. The operative course, clinical and hemodynamic changes, and important observations in this unusual case are described. The availability of noninvasive tests for the measurement of cerebral flow and pressure has made it possible, in this case, to correlate clinical changes with objective evidence of concomitant hemodynamic alterations.