Zusammenfassung
Die Revaskularisation der zentral verschlossenen supraaortalen Gefäße wird zunehmend
mit Erfolg durch extraanatomischen Anschluß an das nächstgelegene supraaortale Nachbargefäß
ausgeführt. Bei hochgradiger Einengung auch dieser Spendergefäße und hohem Risiko
des intrathorakalen Eingriffes ist die Möglichkeit des extraanatomischen Anschlusses
an die seitengleiche femoro-iliakale Strombahn im Sinne der Stromumkehr des axillo-femoralen
Bypass zu erwägen.
Anhand von zwei ausgewählten Fallbeispielen wird demonstriert, daß das Verfahren des
femoro-axillären Bypass sowohl in der elektiven als auch in der Notfallchirurgie seine
Bedeutung hat.
Abstract
Revascularization of central occluded supraaortic vascular branches is more and more
succesfully done by extraanatomic junetion to the nearest other supraaortic vessel.
In case of extreme stenosis of all supraaortic donorvessels intrathoracic surgery
may be exeluded in poor risk patients. The only possibility of extraanatomic junetion
remains connection to iliaco-femoral vessels aecording to the well known femoro-axillary
bypass. Showing two typical cases, this method is demonstrated proving its importance
in elective and emergency surgery.
The first patient (67 yrs. of age) showed an acute complete ischemia of the right
arm due to obstruetion of the subclavian artery distal of the origin of the truneus
brachioeephalicus. Emergency operation was performed, and revascularization was achieved
by femoro-axillary bypass because of biological inoperability to all other orthopic
procedures.
The second case is of a 66 yrs. old patient with abdominal aortic aneurysma and multiple
stenoses of the supraaortic vessels. The abdominal aortic aneurysma was electively
operated upon, and during the same operation the cerebral circulation was hemodynamically
improved by performing a femoro-subclavian bypass.
In considering these two cases, indications, risks and benefits of extraanatomic revascularization
procedures are discussed.
Key words
Extraanatomic vascular surgery - Occlusion of supraaortic vascular branches - Femoro-axillary
bypass
