Indications for ascending aorta-bifemoral bypass grafting in patients with IHD and occlusion of the infrarenal aorta.

The problem concerning surgical decision-making in patients with significant atherosclerotic lesions of arteries of more than one basin will, probably, be important for cardiovascular surgeons for more than one decade. Even the centres possessing experience in several thousand cases of successful treatment of multifocal atherosclerosis have from time to time been facing non-trivial clinical situations requiring a non-standard decision the recommendations for which could hardly be found in the guidelines available, if at all. This article describes the technique and immediate results of an operation making it possible to simultaneously carry out revascularization of the myocardium and lower limbs in patients diagnosed as having a critical coronary lesion and Leriche syndrome with no intervention on the abdominal portion of the aorta. Also given is a detailed description of the technique of performing ascending aorta-bilateral femoral arteries bypass combined with coronary artery bypass grafting. Also presented herein are the data from publications having described this operation previously. Our article for the first time demonstrates the findings of intraoperative flowmetry, proving the leading role of the internal thoracic arteries for collateral blood supply of lower limbs in occlusion of the terminal portion of the aorta. This test lays a pathophysiological foundation for the necessity of a simultaneous intervention on the vessels of two basins.