Axilofemoral bypass in aortoiliac diseases: a case report

Abstract

Introduction: In patients presenting with severe comorbid conditions and infra-renal aortic occlusion, an extra-anatomic bypass stands as one of the viable revascularization options for limb preservation. Axillofemoral bypass offers a valuable alternative in cases involving hostile abdominal environments or infectious aortic aneurysms. To our knowledge, this is the first report from Indonesia of a case of Aortoiliac Occlusive Disease (AIOD). This case report presents a 39-year-old female patient with complaints of left leg pain persisting for the past seven months. Case Description: A 39-year-old female patient sought care at our hospital, reporting left leg pain persisting for the past seven months. The pain worsened during physical activity and subsided during rest. She had a history of hypertension for the last eight years but no diabetes or smoking history. The previous hospital had diagnosed her with peripheral arterial disease, prescribing cilostazol and rivaroxaban, which provided only temporary relief. A computed tomography (CT) angiogram revealed occlusion of the abdominal aorta at the level of L2, extending to the left common iliac and right iliac arteries. We elected to perform an axilla-femoral bypass using a polytetrafluoroethylene (PTFE) graft, which yielded satisfactory results. The patient's progress was monitored for three months postoperatively. This report details the case of a female patient with aortoiliac occlusive disease. Given the absence of insurance coverage for endovascular treatment at our facility, we opted for an axilla-femoral bypass using a PTFE graft, which produced satisfactory outcomes during a three-month follow-up period. Conclusion: The axillofemoral bypass procedure is fairly safe and easy, especially in patients with a high risk of direct aortofemoral bypass and difficult anatomy. The number of collateral vessels in our patients based on CT scans and endovascular procedures that have not been supported by insurance in our hospital makes us choose the axillofemoral bypass option is the action we decided.