One-Staged Operation for Juxtarenal Aortic Occlusion and Myocardial Infarction / 日本心臓血管外科学会雑誌

ABSTRACT

A 59-year-old male suffered dyspnea and ischemia of the lower limbs due to myocardial infarction (occlusion of the right coronary artery and 99% stenosis with delay in the left anterior descending artery) and juxtarenal aortic occlusion, respectively. Juxtarenal aorto-femoral bypass operation using a Y-shaped prosthesis and coronary arterial bypass grafting using the left internal thoracic artery (LITA) and right gastroepiploic artery (RGEA) were performed simultaneously. As the left internal thoracic artery was the route of collateral blood flow to the left lower limb, aorto-femoral bypass was initially made prior to aorto-coronary bypass operation. Because of complete obstruction of the abdominal aorta and juxtarenal lumbar arteries, neither hemodynamic changes nor bleeding occurred during the reconstruction of the abdominal aortic occlusion in spite of severe coronary disease. This procedure was useful for protection of limb ischemia and shortage of extracorporeal circulation time, in addition to producing a route for insertion of an intraaortic balloon pumping catheter.