Abstract：
OBJECTIVE: Despite recent advancements in endovascular technology and proven durability of open surgeries, managing extensive aortoiliac occlusive disease (AIOD) with concurrent severe lower extremity (LE) arterial occlusion remains a formidable challenge. This paper introduces a comprehensive approach to addressing recurrent AIOD and LE occlusive diseases by employing modified-CERAB, inferior mesenteric artery (IMA) snorkel, and LE bypass in a challenging case.
METHODS: A 56-year-old male patient presented with subacute bilateral lower extremity rest pain with dry gangrene in the left great toe and a complex medical history. His history included a hostile abdomen stemming from past ischemic bowel episodes and multiple bowel resections through laparotomies. Furthermore, the patient had a persistent left ventricular thrombus (LVT), stage-2 chronic kidney disease (CKD), diabetes, and was currently experiencing bilateral LE rest pain and dry gangrene in the left great toe, accompanied by severe dermatitis in both LEs.
RESULTS: He successfully underwent modified-CERAB with a concurrent snorkel technique for IMA preservation, along with an LE bypass to resolve bilateral LE critical ischemia.
CONCLUSIONS: This comprehensive management approach, combining simultaneous modified-CERAB, IMA snorkel, and LE bypass, provides an effective alternative for addressing complex AIOD and LE occlusive disease patients with hostile abdomen.
METHODS: A 56-year-old male patient presented with subacute bilateral lower extremity rest pain with dry gangrene in the left great toe and a complex medical history. His history included a hostile abdomen stemming from past ischemic bowel episodes and multiple bowel resections through laparotomies. Furthermore, the patient had a persistent left ventricular thrombus (LVT), stage-2 chronic kidney disease (CKD), diabetes, and was currently experiencing bilateral LE rest pain and dry gangrene in the left great toe, accompanied by severe dermatitis in both LEs.
RESULTS: He successfully underwent modified-CERAB with a concurrent snorkel technique for IMA preservation, along with an LE bypass to resolve bilateral LE critical ischemia.
CONCLUSIONS: This comprehensive management approach, combining simultaneous modified-CERAB, IMA snorkel, and LE bypass, provides an effective alternative for addressing complex AIOD and LE occlusive disease patients with hostile abdomen.
摘要：
目的：尽管血管内技术有了新的进步，开放手术的耐久性也得到了证实，治疗广泛的主髂动脉闭塞性疾病(AIOD)并发严重下肢动脉闭塞(LE)仍然是一项艰巨的挑战.本文介绍了一种通过使用改良的CERAB来解决复发性AIOD和LE闭塞性疾病的综合方法，肠系膜下动脉(IMA)通气管,和LE旁路在一个具有挑战性的情况下。
方法：一名56岁男性患者，表现为亚急性双侧下肢静息痛，左侧大脚趾干性坏疽，病史复杂。他的病史包括因过去的缺血性肠病发作而引起的敌对腹部以及通过开腹手术进行的多次肠切除术。此外，患者有持续性左心室血栓(LVT),2期慢性肾脏病(CKD),糖尿病,目前正在经历双侧LE休息疼痛和左侧大脚趾干性坏疽，两个LEs均伴有严重皮炎。
结果：他成功地接受了改良的CERAB，同时使用浮潜技术进行IMA保存，与LE旁路术一起解决双侧LE严重缺血。
结论：这种综合管理方法，组合同时修改的CERAB，IMA浮潜,和LE旁路，为解决腹部敌对的复杂AIOD和LE闭塞性疾病患者提供了有效的替代方法。
方法：一名56岁男性患者，表现为亚急性双侧下肢静息痛，左侧大脚趾干性坏疽，病史复杂。他的病史包括因过去的缺血性肠病发作而引起的敌对腹部以及通过开腹手术进行的多次肠切除术。此外，患者有持续性左心室血栓(LVT),2期慢性肾脏病(CKD),糖尿病,目前正在经历双侧LE休息疼痛和左侧大脚趾干性坏疽，两个LEs均伴有严重皮炎。
结果：他成功地接受了改良的CERAB，同时使用浮潜技术进行IMA保存，与LE旁路术一起解决双侧LE严重缺血。
结论：这种综合管理方法，组合同时修改的CERAB，IMA浮潜,和LE旁路，为解决腹部敌对的复杂AIOD和LE闭塞性疾病患者提供了有效的替代方法。
