Ascending thoracic aortobipopliteal bypass for extensive aortoiliac and femoropopliteal arterial occlusive disease Pramook Mutirangura, MD, Teravit Phanchaipetch,

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Ascending thoracic aortobipopliteal bypass for extensive aortoiliac and femoropopliteal arterial occlusive disease Pramook Mutirangura, MD, Teravit Phanchaipetch, MD, Chanean Ruangsetakit, MD, Chumpol Wongwanit, MD, Khamin Chinsakchai, MD Journal of Vascular Surgery Cases Volume 1, Issue 2, Pages 180-183 (June 2015) DOI: 10.1016/j.jvsc.2015.04.003 Copyright © 2015 The Authors Terms and Conditions

Fig 1 Evidence of previous arterial bypass procedures. A, Thrombosed left limb of the right axillobifemoral bypass. B, Residual thrombosed graft after the revision procedure from the left limb of the previous bypass to the left proximal popliteal artery, which was subsequently removed. Journal of Vascular Surgery Cases 2015 1, 180-183DOI: (10.1016/j.jvsc.2015.04.003) Copyright © 2015 The Authors Terms and Conditions

Fig 2 Vascular conduit tunneling and placement. After an anastomosis to the ascending thoracic aorta, a 24-mm Dacron (DuPont, Wilmington, Del) tube graft (a) was passed from the pericardial cavity through the diaphragm into the peritoneal cavity. Subsequent to medial rotation of the left-sided abdominal viscera towards the midline, the Dacron tube graft was placed in the left retroperitoneal space and anastomosed to a 24-mm Dacron bifurcation graft (b). Each limb of the Dacron bifurcation graft was anastomosed to an 8-mm ring-reinforced polytetrafluoroethylene (PTFE) graft (c) behind the sigmoid mesocolon. The PTFE grafts were tunneled behind the inguinal ligament to the popliteal fossa on each side. Journal of Vascular Surgery Cases 2015 1, 180-183DOI: (10.1016/j.jvsc.2015.04.003) Copyright © 2015 The Authors Terms and Conditions

Fig 3 Postoperative computed tomography angiography at 1 month, 1 year, and 6 years after surgery shows the continued patency of the ascending thoracic aortobipopliteal grafts. Journal of Vascular Surgery Cases 2015 1, 180-183DOI: (10.1016/j.jvsc.2015.04.003) Copyright © 2015 The Authors Terms and Conditions