Coronary artery bypass grafting and concomitant descending aorta-to-bifemoral artery bypass via sternotomy : case report

Introduction : We evaluated a new approach of combined coronary and aorto-bifemoral artery bypass grafting performed through median sternotomy using the descending aorta as the inflow source. Materials and methods : Four patients with advanced coronary and aorto-iliac disease were operated on in the same session. Following the coronary artery bypass grafting (CABG), we performed a proximal anastomosis of a bifurcated Dacron graft to the descending aorta through the posterior pericardium. The limbs of the graft were passed through the diaphragm into the retroperitoneal space. They were then passed through tunnels in the groins, and distal anastomoses in the groins were performed. Results : The postoperative course was uneventful in all four patients. In the second year, follow-up multi-slice computerised tomographies (CT) and magnetic resonance angiographies were done and all grafts were patent. Discussion : We believe this technique is a reliable alternative procedure to consider in CABG patients who are not suitable candidates for standard aorto-femoral operations. It has a reasonable rate of morbidity and perfect patency.