That was my response when Dr. Linda Harris told me about her plan. She is the program director of vascular surgery here at University at Buffalo, and more importantly she is my mentor. However, I can’t help but second guess the words that were coming out of her mouth.
“Yap, I’ve done it before. It’s the only viable option we have left.”
Alright. Don’t have to tell me twice. I’m going to see this thing through.
The patient is a Caucasian female in her late 50s. She extensive aorto-iliac occlusive disease, and status post past aorto-iliac bypasses that failed and salvaged with stents and fem-fem. The fem-fem was infected and more stents were placed. She is now presenting with postprandial abdominal pain, weight loss and food fear, a classical presentation of chronic mesenteric ischemia, as well as right sided lower extremity rest pain. Her aorta had extensive calcification throughout, and there was no site adequate for an aorto-mesenteric bypass. Fortunately, extra-anatomical bypass was never done for her in the past. CT also revealed a patent hepatic artery despite severe stenosis of SMA, and angiogram showed a patent right profunda artery with distal collateralization.
So the outline of bypass was something like this:
In the end, the patient gained palpable right lower extremity pulses and audible doppler signal throughout the branches of her SMA.
If one knows what she is doing, one can achieve great things in what seems to first timers as really funky ways.