Search

We performed an extended extra-anatomic bypass to salvage the both lower extremities in a diabetic and obes woman who had critical ischemia in her both lower extremities. Patient also had several abdominal operations. The patient did not have a good arterial vasculature as inflow or outflow conduit in the right femoral region and she also had femoro-popliteal bypass which was occluded on the left lower limb. Firstly, trombectomy was performed to the occluded graft. Secondly, left axillofemoral, thirdly, left to right cross-over, finally, femoro-popliteal bypasses were performed to make an axillobipopliteal bypass functionally. The case will be evaluated under the literature knowledge.

Aim: The aim of this study was to evaluate the early and mid-term results of total arterial myocardial revascularization in elderly patients. Material and Method: 65 patients aged 60 years and older (mean 64.8+5.4, range 60-78 years) who underwent total arterial myocardial revascularization between January 2002 and June 2004 were evaluated prospectively. 41 patients (63.1%) had three-vessel coronary artery disease, 18(27.7%) had two-vessel disease and 6(9.2%) with left main lesion. 22 patients had an old myocardial infarction and 11 unstabile angina pectoris. Mean EF was 55%. All patients underwent TAMR. In total 167 distal anastomoses were constructed (2.6 per patient) Pedicled LITA and RITA, free RITA and Radial arter were used as single or composite T-or Y- graft. Results: Patient were followed-up in a mean period of 17.6+7.3 months (range 1-28 month). There was no ocluded grafts in the early postoperative period (less than 90 days) patency 100%. Late(mean 16+2 month) LITA patency was 98.1% (one graft ocluded), RITA patency was 93.4% (one graft ocluded) and RA patency was 93.2% (three grafts ocluded).One patient died in this period (1.5%) one underwent PTCA (1.5%) two suffered angina pectoris (3.1%), there was no reoperation in this period. Conclusion: This study showed that using only arterial conduits in coronary bypass surgery in elderly (patient aged over 60 years) were clearly evident with respect to higher patency rate, surgical reintervention and freedom from cardiac events., Aim: The aim of this study was to evaluate the early and mid-termresults of total arterial myocardial revascularization in elderlypatients.Material and Method: 65 patients aged 60 years and older (mean64.8+5.4, range 60-78 years) who underwent total arterial myocardial revascularization between January 2002 and June 2004 wereevaluated prospectively. 41 patients (63.1%) had three-vessel coronary artery disease, 18(27.7%) had two-vessel disease and 6(9.2%)with left main lesion. 22 patients had an old myocardial infarctionand 11 unstabile angina pectoris. Mean EF was 55%. All patientsunderwent TAMR. In total 167 distal anastomoses were constructed(2.6 per patient) Pedicled LITA and RITA, free RITA and Radialarter were used as single or composite T-or Y- graft.Results: Patient were followed-up in a mean period of 17.6+7.3months (range 1-28 month). There was no ocluded grafts in theearly postoperative period (less than 90 days) patency 100%.Late(mean 16+2 month) LITA patency was 98.1% (one graft ocluded), RITA patency was 93.4% (one graft ocluded) and RA patencywas 93.2% (three grafts ocluded).One patient died in this period(1.5%) one underwent PTCA (1.5%) two suffered angina pectoris(3.1%), there was no reoperation in this period.Conclusion: This study showed that using only arterial conduits incoronary bypass surgery in elderly (patient aged over 60 years) wereclearly evident with respect to higher patency rate, surgical reintervention and freedom from cardiac events.

Left ventricular pseudoaneurysms (LVPA) develop after myocardial infarction, trauma, infection and either valvular or ventricular surgery. We present here an unusual case of LVPA appearing like a pulsatile mass, which was easily seen from the chest wall. A 55-year-old woman was admitted to our clinic with a pulsatile mass and trill, easily seen on the anterior chest wall 6 weeks after coronary artery bypass graft (CABG) surgery and endoaneurysmorrhaphy operation. Contrast-enhanced tomography showed a soft tissue mass detected close to the subcutaneous fat tissue of the anterior chest wall located in the left hemithorax. Left ventriculography was consistent with a large pseudoaneurysm in the apical wall of the left ventricle. Cardiopulmonary bypass was established with femoral cannulation, and endoaneurysmorrhaphy and CABG x 1 operations were carried out. The patient was discharged home on postoperative day 15. Follow-up echocardiography showed successful repair and shrinkage of the aneurysm, and the patient remained asymptomatic without any clinical event during our follow-up. LVPA usually present with heart failure. However, some patients may have recurrent tachyarrhythmia, progressive dyspnea, nonspecific chest pain, or thromboembolism, or remain clinically silent. When a patient is seen after cardiac surgery with a pulsatile mass detected on the chest wall, LVPA should be considered in the differential diagnosis.