An artist's sketch of complex reconstructive surgery

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An artist's sketch of complex reconstructive surgery An artist's sketch of complex reconstructive surgery. A 60-year-old female patient with a history of heaving smoking and COPD had complete occlusion of aortobifemoral bypass graft which was formally inserted at an outside institute. The patient now presented with ischemic symptoms in the lower extremities, in addition to symptomatic left subclavian steal syndrome. These were documented and a duplex scan, MRA, and angiogram (not shown here) were given. After a previous abdominal aortobifemoral bilateral femoral artery bypass, the patient developed a massive wound infection, Bentyl hernia requiring abdominal wall reconstruction and mash. Because of COPD, the left thoracotomy for the descending thoracic aorta, bilateral femoral artery bypass was deemed unwise. Therefore, a mini sternotomy was performed using a side-bitting clamp at the ascending aorta, end-to-side anastomosis was made between proximal end of a No. 18 Hemashield Dacron graft and to the side of aorta. Then the Dacron graft limbs were extended using a No. 8 PTFE graft with rings. This graft was tunneled under the sternum then preperitoneally, subcutaneously down to both femoral artery systems for distal anastomosis. At the same sitting, a bypass graft was extended to the left subclavian artery from the Dacron graft within the chest (arrow). Source: Lower Extremity Revascularization for Atherosclerotic Occlusive Disease, Peripheral Arterial Disease Citation: Dieter RS, Dieter RA, Jr., Dieter RA, III. Peripheral Arterial Disease; 2016 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/1789/dieperi_ch37_f008.png&sec=123049601&BookID=1789&ChapterSecID=123049469&imagename= Accessed: December 24, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved