Femoral Bypass Graft Research Articles

The Effect of Aerobic and Combined Training on Heart Function of Middle-ged Male Patients After Bilateral Femoral Artery Coronary Grafting

Background and Aims Cardiovascular diseases are among the most common causes of death in the world. The prevalence of cardiovascular diseases increases with older age. Using cardiac exercise training to rehabilitate the heart after heart disease creates functional and structural adaptations in the patient’s cardiovascular system, reducing mortality from related diseases. Therefore, this study aimed to investigate the effect of two aerobic and combined exercise training methods on heart function capacity in middle-aged male patients after bilateral femoral artery coronary bypass grafting surgery. Methods In this quasi-experimental study with a pre-test-post-test design, 68 middle-aged male patients (Mean±SD age: 56.19±1.26 years) were studied after bilateral femoral artery coronary bypass grafting surgery. The subjects were randomly and availably divided into 3 groups: Aerobic (n=20), combined exercise training (aerobic+resistance) (n=20), and control (n=28). The subjects in the intervention groups performed 8 weeks of training, 3 sessions per week. Each training session in the aerobic and combined groups was performed for 40 minutes with the intensity of 70-85% heart rate reserved and 60 minutes with the intensity of 40-80% of one repetition maximum for each patient. Levene’s test, multivariate analysis of variance (MANOVA), and Bonferroni statistical tests were used to analyze the obtained data at the significance level of P≤0.05. Results The one-way MANOVA test showed that functional capacity, ejection fraction and maximal oxygen consumption increased significantly after aerobic and combined exercise training compared to the control group (P<0.05). However, the Bonferroni post hoc test showed no significant differences between functional capacity, ejection fraction, and maximal oxygen consumption at post-test levels in aerobic and combined exercise training groups (P>0.05). Conclusion The findings of this study show that both aerobic and combined exercise training can improve the heart functional variables in middle-aged male patients after bilateral femoral artery coronary bypass grafting surgery, and these improvement levels appear to be independent of the types of training.

Intravascular lithotripsy to address calcific aortic disease

Intravascular Lithotripsy (IVL) is a relatively modern endovascular tool accepted for use to address vascular calcification in the iliac arterial system and below. This case study shows evidence of successful application of IVL followed by stent placement to calcific disease present within the aorta as well. A 78-year-old female with numerous comorbidities and a history of an aorto right femoral left iliac bypass graft in 1998 presented with severe lifestyle limiting claudication secondary to high-grade atherosclerotic stenosis of her infrarenal abdominal aorta at the level of the proximal anastomosis of her bypass graft. Initial ABIs were 0.54 and 0.55 on the right and left respectively. Initially the operative plan was to conduct a retroperitoneal aortic endarterectomy. However, after the surgical optimization center deemed the patient intermediate risk and her pulmonary function decreased prior to the procedure, the decision was made to proceed with IVL followed by angioplasty and aortic stent placement. The patient tolerated the procedure well without complication and she was discharged home the following day. At follow up appointment 6 weeks later, the patient's repeat ABIs were significantly improved to 0.77 in the right and 0.86 in the left with a coinciding improvement in symptoms. In conclusion, IVL is safe and effective in calcific aortic disease and should be considered in patients who are not optimal open surgical candidates.

Fresh arterial allograft as a replacement for an infected common femoral prosthetic graft and recurrent false aneurysm.

Replacing an infected vascular prosthetic conduit with an allograft is a possible solution of this complication given the low recurrence of infection. It is most commonly utilized for cases where the use of autologous tissue is not an option. We present the case of a 70-year-old patient who had undergone repeated vascular reconstructions in the right lower limb. He was admitted to our department due to a progressively growing mass in the right groin and subsequently placed on the waiting list for a fresh allograft. The patient had the infected false aneurysm and prosthetic material of the femoral bifurcation replaced with an arterial allograft. The previous femoral popliteal autovenous bypass graft was reimplanted into the allograft. There were signs of sepsis during the operation; however, the blood culture was negative. Cultures from neither the wound nor the drain revealed the presence of any bacteria. The patient was discharged on the seventh post-operative day with prophylactic antibiotics. An early followup confirmed that there were no signs of recurrent infection and that the reconstruction remained patent. Seven and half months after the surgery, the femoral popliteal bypass graft became occluded and a conservative approach was chosen. A small thrombosed false aneurysm of the graft was revealed two years after the surgery due to transient non-compliance of the patient to immunosuppression therapy. It was treated conservatively. Two and a half years after the surgery, the allograft still remains open and the limb is preserved.

Two methods of aerobic and combined training on biomechanics of Vessels in patients after bilateral femoral artery coronary grafting

Background: Cardiovascular disease is one of the most common causes of death in the world and its prevalence increases with age. For the purpose of cardiac rehabilitation after heart disease, performing exercise training causes functional and structural adaptations in patient’s cardiovascular system and consequently reduces mortality from related diseases. Therefore, the aim of this study was to investigate the effect of two methods of aerobic and combined exercise training biomechanics of blood in middle-aged patients after bilateral femoral artery coronary bypass grafting surgery. Materials and Methods: In this semi-experimental study with a pre-post test design, 68 middle-aged men (mean age 56.19± 1.26 years) were studied after bilateral femoral artery coronary bypass grafting surgery. Subjects were randomly and availably divided into 3 groups: aerobic (n =20) and combined (aerobic + resistance) (n =20) exercise training, and control groups (n =28). Subjects in the intervention groups performed 8 weeks of training/3 sessions per week. Each training session in aerobic and combined groups was considered for 40 minutes with the intensity of 70-85% heart rate reserved, and 60 minutes with the intensity of 40-80% one repetition maximum for each patient, respectively. In order to analyze the data, Leven, MANOVA and Bonferroni statistical tests were used at the significance level of P≤0.05. Results: The results of one-way MANOVA test showed that the levels of functional capacity, ejection fraction and maximal oxygen consumption were increased significantly after aerobic and combined exercise training compared to control group (p <0.05). However, Bonferroni post hoc test showed no significant differences between functional capacity, ejection fraction and maximal oxygen consumption post-test levels in aerobic and combined exercise training groups (p> 0.05). Conclusion: the findings of this study show that both aerobic and combined exercise training can improve the heart functional variables in middle-aged patients after bilateral femoral artery coronary bypass grafting surgery, and this improvement levels appears to be independent of the types of training.

Abstract 12256: Symptomatic Supratherapeutic International Normalized Ratio on Rivaroxaban: A Case Report and a Systematic Review

Rivaroxaban is a direct oral anticoagulant that works by inhibiting factor Xa. Direct anticoagulants have largely replaced direct vitamin K inhibitors (VKAs) due to the increased risk of major hemorrhages and the need for regular monitoring and dose adjustments. However, there have been multiple reports of elevated international normalized ratio (INR) and incidents of bleeding in patients on rivaroxaban, which brings into question the potential need for monitoring. The purpose of this review is to differentiate the patients that may benefit from regular monitoring and to propose future directions for implementation of monitoring. Here we report a case of an INR of 4.8 in a patient who presented with a gastrointestinal bleed and a drop of five gm/dL in hemoglobin four days after starting rivaroxaban following right femoral popliteal bypass graft stenting. The patient had no liver or kidney abnormalities and was not taking any medication or consuming any foods that could introduce any significant drug interaction. Additionally, we conducted a systematic review of similar reports in the literature with the goal of identifying the factors that could influence rivaroxaban’s levels in the blood or its influence on the INR. We reviewed PubMed using keywords including; “rivaroxaban”, “anti-Xa”, “DOAC”, “elevated”, “INR”, “bleeding”, “hemorrhage”, “pharmacology”, and “pharmacokinetics”. The literature revealed reports of INRs up to 5.2. Reviewing the pharmacokinetics of rivaroxaban indicated possibly higher drug levels in Caucasians, patients with a low body mass index (BMI), and patients with polymorphisms in the genes coding for CYP3A4, CYP2J2, or p-glycoprotein, assuming no renal or liver disease and no significant drug-drug or drug-food interactions. INR can be falsely normal if the thromboplastin reagent used to monitor the INR on warfarin is not sensitive to the changes in INR due to rivaroxaban. We suggest finding a thromboplastin reagent that is sensitive to INR changes with rivaroxaban, which could yield clinically relevant INRs on rivaroxaban allowing for accurate monitoring. We then suggest conducting studies to evaluate the cost effectiveness of regular monitoring in at-risk patients.

Axillary pullout syndrome: an unusual complication of axillary femoral bypass grafting

Axillary pullout syndrome: an unusual complication of axillary femoral bypass grafting

Results of Obturator Foramen Bypass in Patients with Groin Infection and Arterial Involvement

Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts. A multihospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow-up was included in the trial. Demographic, operative, and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio. Seventeen patients underwent OFB during the defined time-period. Demographic data are presented in the first table (Demographic Characteristics). Mean American Society of Anesthesiologists score was 3.25. Mean estimated blood loss was 500 mL. Mean operative time was 307 min. Mean follow-up time was 8.5 months (range 0-35 months). In total, 41.2% patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (P value 0.3). In total, 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. The overall mean length of stay was 16.8 days. Two major amputations were reported during follow-up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use was not associated with an increased number of subsequent groin wound procedures (P value 0.3). Intravenous drug use was not associated with concomitant methicillin-resistant Staphylococcus aureus infection (P value 0.3). OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at midterm follow-up.

Management of patch infections after carotid endarterectomy and utility of femoral vein interposition bypass graft

ObjectivePatch infection after carotid endarterectomy (CEA) is a rare but devastating complication. A variety of different treatment options are reported; however, there is currently no consensus on how to manage this highly morbid problem. The purpose of this study was to review our experience with management of infectious patch complications after CEA and to highlight utility of femoral vein interposition bypass grafting. MethodsAll CEA patch infection operations at the University of Florida from 2002 to 2017 were reviewed retrospectively. Preoperative history, intraoperative details, and postoperative complications were recorded. Bypass patency was verified with duplex ultrasound imaging (1 month, 6 months, annually). The primary end point was 30-day stroke or death; secondary end points included cranial nerve injury, reintervention, reinfection, and survival. Life tables were used to estimate end points. ResultsTwenty-nine patients (mean age, 70 ± 9 years; male, 76%) were identified. The index CEA occurred at a median of 15 months (interquartile range, 1-55 months) preoperatively (39% <2 months after the index procedure). A variety of patch materials were implicated (Dacron, n = 9; unknown/undocumented, n = 8; bovine pericardium, n = 5; expanded polytetrafluoroethylene, n = 3; unidentified nonbiologic prosthetic, n = 3; saphenous vein, n = 1). Carotid reintervention antecedent to the infected patch presentation occurred in 41% (incision and drainage, n = 10; carotid stent, n = 2; vein patch, n = 1). The most common infecting organisms were Staphylococcus and Streptococcus species (52%; n = 15). The most frequent presentation (46%; n = 13) was pericarotid abscess or phlegmon (pulsatile neck mass or pseudoaneurysm, 28% [n = 8]; carotid-cutaneous fistula, 28% [n = 8]). Reconstruction strategy included femoral vein interposition bypass in 24 patients (83%; nonreversed configuration, 16/24 [67%]), saphenous vein patch in 4 patients (14%), and femoral vein patch in 1 patient (3%). Median postoperative length of stay was 5 days (interquartile range, 4-8 days). Twelve patients (41%) experienced a complication, and the 30-day stroke/death rate was 7% (death, n = 1; stroke, n = 1). The single postoperative death occurred in a patient with history of congestive heart failure who developed a pulseless electrical activity arrest on postoperative day 11 that resulted in multiorgan system failure. Cranial nerve injury occurred in 28% (n = 8; cranial nerves X [3], VII [2], XII [2], and IX [1]), all of which resolved by last follow-up. In follow-up (mean clinical follow-up, 17 ± 14 months; mean survival time, 108 months [95% confidence interval, 81-135 months]), two (7%) complained of limb edema with femoral cutaneous nerve palsy that resolved by 3 months. One interposition bypass occluded at 3 months (asymptomatic); the remaining grafts remained patent with no restenosis, reinfection, or reintervention events. The 1- and 5-year survival was 87% ± 6% and 82% ± 8%, respectively. ConclusionsCEA patch infection can be successfully managed with femoral vein interposition bypass with acceptable postoperative outcomes. Excellent patency can be anticipated with good long-term survival. This strategy can be considered especially in cases with carotid size mismatch or if there is limited availability of alternative biologic conduits.

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

Treatment of peripheral arterial disease via percutaneous brachial artery access

ObjectiveThis review was conducted to evaluate the types of endovascular procedures that can be performed via brachial artery access, evaluate the access success rate, and determine the incidence of technical complications. MethodsA retrospective 10-year record review at a tertiary facility from January 1, 2005, through June 30, 2015, was completed. Patients who underwent attempted brachial artery access were eligible for review. Outcomes intended to be evaluated included ability to access the vessel, reach an identified lesion, and perform an indicated procedure, while describing the incidence and type of complications that occurred to clarify the utility and safety of brachial artery access. ResultsThe review included 265 access cases in 179 patients. The access success rate was 98.9%. Intervention was performed in 223 cases (84.2%). Angioplasty was the most common intervention (59%, [154 cases]), with stents, atherectomy, coiling, and percutaneous thrombectomy having also been performed. Complications included hematoma (2.3%) and pseudoaneurysm (1.5%). Complications requiring intervention occurred in 1.9% of procedures. Interventions were performed on all major vessels as distal as the dorsalis pedis. Sheath sizes ranged from 4F to 7F. Intervention was performed on bilateral lower extremities in 38 cases (14.5%). A femoral bypass graft was present in 141 patients (53%) as the main indication for brachial artery access. ConclusionsBrachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated postprocedure “hold team.”

Descending thoracic aorta to femoral bypass grafting for total abdominal aortic occlusion

Descending thoracic aorta to femoral bypass grafting for total abdominal aortic occlusion

Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap.

Purpose:The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele.Materials and Methods:We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009.Results:Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period.Conclusion:We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.

Abstract 165: cAMP-Phosphodiesterase 1C Regulates Neointimal Hyperplasia by Controlling Platelet-Derived Growth Factor Receptor ß Degradation via the Endosome-Lysosome Pathway

Neointimal hyperplasia is associated with the development of diverse vascular diseases such as atherosclerosis, vein bypass graft disease and restenosis after percutaneous coronary interventions. Vascular injury-mediated neointimal hyperplasia involves the phenotypic modulation, migration and proliferation of vascular smooth muscle cells (VSMCs). Cyclic nucleotide is vital in regulating VSMC migration and proliferation, which are controlled by cyclic nucleotide phosphodiesterase (PDE) isozymes. To identify the regulation and function of PDEs in VSMC pathogenesis of vascular diseases, we performed systematic screening for all 22 known PDE genes in normal contractile VSMCs and proliferating synthetic VSMCs. Interestingly, we observed that expression of PDE1C was very low in normal contractile VSMCs but drastically elevated in synthetic VSMCs in vitro as well as in vivo in various mouse models of vascular injuries, including carotid artery ligation, femoral artery wire injury and vein bypass graft. Consistently, PDE1C is also highly induced in VSMCs in neointimal lesion of human coronary artery. More importantly, injury-induced neointimal formation was significantly attenuated in pde1c-deficient mice or by perivascular administration of PDE1 inhibitor. Furthermore, PDE1 inhibition also reduced the spontaneous vascular remodeling of human saphenous vein explant in an ex vivo culture model. Mechanistic studies revealed that PDE1C plays a critical role in regulating the stability of PDGF receptor beta (PDGFR-β). We found that PDE1C knockdown or inhibition markedly decreased the levels of PDGFR-β protein but not mRNA, which was blocked by endosome and lysosome inhibitors. Furthermore, PDE1C inhibition is capable of promoting PDGFR-β internalization and attenuating PDGFR-β membrane accumulation. Finally, we found that PDE1C co-localized with PDGFR-β on cell membrane, which was able to regulate PDGFR-β protein degradation through modulating a transmembrane adenylyl cyclase-cAMP-PKA signaling. Taken together, our present data demonstrated that PDE1C plays a critical role in regulating VSMC proliferation and neointimal hyperplasia, in part, through promoting endosome/lysosome dependent PDGFR-β protein degradation.

Topology optimization of the shear thinning non-Newtonian fluidic systems for minimizing wall shear stress

This paper suggests the topology optimization process to minimize wall shear stress by considering shear thinning non-Newtonian fluid effects in the systematic design of fluidic systems dealing with blood. Topology optimization was originally developed for mechanical design problems, and within the last decade the method has been extended to a range of fluidic applications. In this paper, the Carreau–Yasuda constitutive equation model is used for shear thinning non-Newtonian fluid modeling. The fundamental idea is that the material density of each element or grid point is a design variable, thus, the geometry is parameterized in a pixel-like pattern. Then, material interpolation functions for inverse permeability and dynamic viscosity are used to ensure convergence of the solution and resolve non-linearity. In order to define wall shear stress on implicit boundary between solid and fluid (i.e., blood) occurring in fluidic topology optimization, the relaxation method of wall shear stress is first proposed in this study. We then apply the proposed fluidic topology optimization to actual fluidic systems dealing with blood (e.g., a femoral bypass graft). These design examples validate the efficiency of the proposed approach and show that topology optimization can be used for the initial conceptual design of various fluidic systems.

A reduced computational and geometrical framework for inverse problems in hemodynamics

The solution of inverse problems in cardiovascular mathematics is computationally expensive. In this paper, we apply a domain parametrization technique to reduce both the geometrical and computational complexities of the forward problem and replace the finite element solution of the incompressible Navier-Stokes equations by a computationally less-expensive reduced-basis approximation. This greatly reduces the cost of simulating the forward problem. We then consider the solution of inverse problems both in the deterministic sense, by solving a least-squares problem, and in the statistical sense, by using a Bayesian framework for quantifying uncertainty. Two inverse problems arising in hemodynamics modeling are considered: (i) a simplified fluid-structure interaction model problem in a portion of a stenosed artery for quantifying the risk of atherosclerosis by identifying the material parameters of the arterial wall on the basis of pressure measurements; (ii) a simplified femoral bypass graft model for robust shape design under uncertain residual flow in the main arterial branch identified from pressure measurements.

Remodeling leads to distinctly more intimal hyperplasia in coronary than in infrainguinal vein grafts

Flow patterns and shear forces in native coronary arteries are more protective against neointimal hyperplasia than those in femoral arteries. Yet, the caliber mismatch with their target arteries makes coronary artery bypass grafts more likely to encounter intimal hyperplasia than their infrainguinal counterparts due to the resultant slow flow velocity and decreased wall stress. To allow a site-specific, flow-related comparison of remodeling behavior, saphenous vein bypass grafts were simultaneously implanted in femoral and coronary positions. Saphenous vein grafts were concomitantly implanted as coronary and femoral bypass grafts using a senescent nonhuman primate model. Duplex ultrasound-based blood flow velocity profiles and vein graft and target artery dimensions were correlated with dimensional and histomorphologic graft remodeling in large, senescent Chacma baboons (n = 8; 28.1 ± 4.9 kg) during a 24-week period. At implantation, the cross-sectional quotient (Q(c)) between target arteries and vein grafts was 0.62 ± 0.10 for femoral grafts vs 0.17 ± 0.06 for coronary grafts, resulting in a dimensional graft-to-artery mismatch 3.6 times higher (P < .0001) in coronary grafts. Together with different velocity profiles, these site-specific dimensional discrepancies resulted in a 57.9% ± 19.4% lower maximum flow velocity (P = .0048), 48.1% ± 23.6% lower maximal cycling wall shear stress (P = .012), and 62.2% ± 21.2% lower mean velocity (P = .007) in coronary grafts. After 24 weeks, the luminal diameter of all coronary grafts had contracted by 63%, from an inner diameter of 4.49 ± 0.60 to 1.68 ± 0.63 mm (P < .0001; subintimal diameter: -41.5%; P = .002), whereas 57% of the femoral interposition grafts had dilated by 31%, from 4.21 ± 0.25 to 5.53 ± 1.30 mm (P = .020). Neointimal tissue was 2.3 times thicker in coronary than in femoral grafts (561 ± 73 vs 240 ± 149 μm; P = .001). Overall, the luminal area of coronary grafts was an average of 4.1 times smaller than that of femoral grafts. Although coronary and infrainguinal bypass surgery uses saphenous veins as conduits, they undergo significantly different remodeling processes in these two anatomic positions.

Spinal Cord, Bowel, and Buttock Ischemia After Endovascular Aneurysm Repair

A 66-year-old man with multiple comorbidities presented with a juxtarenal perianastomotic aortic aneurysm 10 years after open abdominal aortic aneurysm repair. The aneurysmal disease also involved both iliac bifurcations, the right internal iliac artery, the left common femoral artery (CFA) up to its bifurcation, and the homolateral popliteal artery. We performed bilateral internal iliac artery coil embolization 1-month apart. Later, we performed aortouniiliac endografting extending to the right external iliac artery and placement of an endovascular plug in the left external iliac artery. A right CFA to left femoral bifurcation bypass graft was then constructed after ligation of the left CFA aneurysm. After recovering from anesthesia and despite sequential hypogastric embolization, the patient developed postoperative paraplegia, buttock ischemia, and ischemic colitis and died on postoperative day 5. The possible pathogenic mechanisms involved in the onset of these ischemic complications are discussed in this article.

Development of femoro-femoral and axillo-femoral bypass procedures

Development of femoro-femoral and axillo-femoral bypass procedures

Vascular Nosocomial Nocardia farcinica Infection After Arterial Stenting in an Immunocompetent Patient

Vascular Nosocomial <i>Nocardia farcinica</i> Infection After Arterial Stenting in an Immunocompetent Patient

Monitored anesthesia care with remifentanil for femoro-femoral bypass graft patients

Monitored anesthesia care with remifentanil for femoro-femoral bypass graft patients