One-stage coronary, carotid, aortobifemoral, and femoropoliteal surgery for concomitant critical ischemia in three vascular beds

摘要

TO THE EDITOR: Arteriosclerosis, as a systemic pathological process, might affect concurrently all major arterial segments of the vascular system. The challenge for the cardiovascular surgeon is to select the optimum sequence, timing and mode of revascularization. Generally the priority is to deal with the more unstable vascular bed first. Most patients present with critical ischemic symptoms from only one arterial territory. The situation becomes more complex when an unstable cardiac condition occurs concomitantly with grave ischemia of the lower limbs and the carotid circulation. Although therapeutic strategies of simultaneous coronary artery disease and peripheral arterial disease has been reported before, surgical treatment of these three pathologies as an one-stage procedure has barely been described. We have been faced with and have treated a patient with this intricate clinical problem and our experience is presented.