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Aortectomy and axillary-bifemoral bypass

Case contributed by Jan Frank Gerstenmaier
Diagnosis certain

Presentation

This patient had a previous EVAR which got infected and subsequently got explanted along with the native distal aorta.

Patient Data

Age: 55 years
Gender: Male

There is normal mediastinal vascular enhancement and aorta branching

pattern. Normal aortic arch and descending aorta. Stump with surgical clips demonstrated at the L1-L2 level, similar to previous. Patent celiac and superior mesenteric arteries. No opacification of the inferior mesenteric artery. Reconstitution of the pelvic vasculature from the distal aspects of the common iliac arteries with patency to the external and internal arteries.

Left external iliac graft runs through the anterior abdominal soft tissues  and joins a graft from the right common femoral artery within the right side of the  abdominal subcutaneous tissues, traveling superiorly to eventually joining to the  right subclavian artery. Graft and arteries are patent. No contrast extravasation.  No evidence for anastomotic stenosis.

Case Discussion

There is nothing wrong with the graft; it is just an example of some serious plumbing.

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