Revascularization Alternatives In Young Patients With Aorto-Bifemoral Bypass Occlusion - For The Purposes Of 3 Clinical Cases.

Introduction Despite the continuous expansion of endovascular treatment in the aorto-iliac sector, the aorto-bifemoral bypass is still the gold standard for revascularization in TASC C / D occlusive disease, especially in patients with favorable surgical risk. Late occlusion of aortic grafts in young patients is challenging, as a long-term revascularization alternative is required. Objectives The authors present 3 clinical cases of complete late infrarenal- bifemoral aortic bypass occlusion in young patients, submitted to different forms of revascularization, favouring the maintenance of aortic inflow. Materials and Methods Two men and one woman, with a mean of 59 years of age, smokers, without relevant heart or lung diseases, admitted for complete late occlusion of infrarenal-bifemoral aortic bypass, two with critical ischemia and one with acute ischemia of the limbs lower. After a study by computed tomographic angiography, they underwent revascularization using a supra-celiac-bifemoral aortic bypass, a para-renal-bifemoral aortic bypass and a bilateral femoral graft thrombectomy complemented by covered kissing stent. In all patients, revascularization of the lower limbs was successful and there were no relevant postoperative complications. Results After an average clinical and imaging follow-up of about one year, patients are asymptomatic and with the revascularizations in good condition. Conclusions The clinical cases presented show the efficacy of revascularization alternatives with maintenance of aortic inflow in patients with aorto-bifemoral bypass occlusion. Despite the increased complexity of these interventions, they are, in selected patients, safe and durable.