Hybrid operations for complex mixed, aortic and common iliac artery pathologies
Article written by: Dr. Jerôme Cau
Medical Procedures
- Cholecystectomy
- Hernia
- Limfadenectomy
- Esophageal Tumor Resection
Conditions Treated
Abdominal Conditions
- Gallbladder Disease
- Tumors of the Stomach, Liver, Pancreas
- Intestinal Pathologies
Pelvic and Perineal Conditions
- Rectal, Utero-Vaginal Prolapse
- Perineal Corrections
Other Conditions Treated
- Thyroid
- Abdominal Lymphadenectomies
- Esophageal Tumors
- Gallbladder Disease
- Tumors of the Stomach, Liver, Pancreas
- Intestinal Pathologies
- Rectal, Utero-Vaginal Prolapse
- Perineal Corrections
- Thyroid
- Abdominal Lymphadenectomies
- Esophageal Tumors
There are complex cases where patients have extensive arterial disease involving both the aortic artery (such as an aneurysm) and the iliac artery. The main goal in such situations is to properly revascularize the affected arteries. This may require a combined, hybrid approach to achieve the best results.
When it comes to abdominal aortic diseases, two types of approaches can be used: the classical or the endovascular approach (EVAR), the choice depending on the particularities of each case.
In the present case, the lesion of the common iliac artery required a crossed femoral-femoral bypass, performed in the same operative session as EVAR.
Why is EVAR necessary?
The EVAR procedure is designed to prevent a potentially fatal rupture of the abdominal aorta. EVAR involves placing a special tube, called an endograft, inside the aorta. This endograft, made of a metal mesh covered with fabric, creates a new channel for blood to circulate, reducing the pressure on the wall of the affected artery.
The EVAR procedure
Patient preparation: The procedure is performed under general anesthesia;
Incision: The surgeon makes a small incision in the groin to access the femoral artery;
Catheter insertion: A flexible tube (catheter) is inserted through this incision and guided up to the aneurysm;
Endograft placement: The endograft is inserted through the catheter and positioned inside the aorta, covering the aneurysmal area. It expands and firmly attaches to the artery wall, redirecting blood flow.
Closing the incision: After placement of the endograft, the catheter is withdrawn and the incision is closed.
Femoral-Femoral Bypass: A life-saving procedure for peripheral arterial disease
Femoral-Femoral Bypass is a surgical intervention indicated for patients with severe occlusive disease of the iliac artery. It may be chosen when other methods such as angioplasty or stenting are not possible or have failed.
Indications for Femuro-Femoral Bypass
Femuro-Femoral Bypass is recommended for patients who present with:
Severe symptoms such as claudication (pain on walking);
Persistent pain at rest;
Risk of tissue loss.
Surgical technique
The procedure involves creating a connection between the two femoral arteries to allow blood to bypass the blockage in the iliac artery.
Incisions are made in the groin to access the femoral arteries;
A synthetic or venous graft is inserted and tunneled under the skin, connecting the two femoral arteries;
The graft is carefully secured at both ends to ensure optimal blood flow;
The incisions are carefully closed and the patient is closely monitored.
Post-operative care
Recovery after femoral-femoral bypass involves hospitalization for several days, during which time the medical team monitors the function of the graft and manages pain or other possible complications. Regular check-ups are essential to ensure optimal blood flow is maintained.
Potential Complications
Although femoral-femoral bypass is considered a safe procedure, complications can sometimes occur such as:
-Incisional infections;
-Graft blockage;
-Limb ischemia.
These risks can be reduced by careful planning, careful surgical technique and appropriate postoperative medical care.
Conclusion Femoral-femoral bypass
Femoral-femoral bypass is a valuable surgical option for patients with severe peripheral arterial disease. By bypassing obstructions in the iliac arteries, this procedure can significantly improve blood flow to the lower extremities, relieving symptoms and improving patients’ quality of life.
Results:Following this type of hybrid surgery we achieved reavascularization of the affected areas in the correct way.
Notes: In general this type of patients may also have other type of arterial diseases that in some cases need to be resolved before this step, but in general they are less complex, angioplasties and/or endarterectomies.
Medical Consultant: Prof. Dr. Jérôme Cau