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Treatment of Claudication in Obese Male with Aorto-Femoral Bypass Surgery

A 58-year-old male, obese with a BMI of 37, presents with 6 months of worsening hip, buttock, and thigh claudication. His medical history includes type 2 diabetes, hypertension, and significant smoking history. Physical examination reveals diminished femoral pulses and severe aortic narrowing. Non-invasive testing shows ABI values significantly below normal. Surgical options discussed include aorto-femoral bypass and aortic endarterectomy. The patient underwent successful aorto-femoral bypass with improvement in claudication symptoms and increased ABI to 0.9. Discharged after 16 hours post-procedure.

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Treatment of Claudication in Obese Male with Aorto-Femoral Bypass Surgery

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  1. History & Physical • 58 yo obese male (VA hospital employee) c/o 6 mo worsening hip, buttock, thigh claudication. Requires 30 minutes to walk 1.5 blocks. Denies rest pain, tissue loss, impotence. • PMH: IDDM x 10 years, HTN, morbid obesity (BMI=37), smoking 1ppdx40 years • PSH: appy • Meds: HCT, lisinopril, atenolol, metformin, aspirin, lovastatin • Exam: diminished femoral pulses bilateral, non-palpable popliteal or distal pulses • Non-invasive labs: monphasic waveforms B ankles, ABI R=0.72, L=0.65

  2. Severe aortic narrowing IMA 4 CM LENGTH

  3. Options • Aorto-femoral bypass • Aortic endarterectomy • Bare-metal stent • Covered stent

  4. ZENITH AAA STENT-GRAFT ILIAC EXTENDER CUFF IS TOO LONG

  5. EXTENDER CUFF IS DEPLOYED ON A SIDE TABLE, CUT IN 1/3, AND REMOUNTED PRIOR TO REENTRY INTO PATIENT’S AORTA

  6. 10mm balloon

  7. 12mm balloon

  8. PATENT IMA

  9. Follow-up • Strong femoral pulses • No further pain with ambulation up to 3 blocks • Discharged home 16 hours post procedure • ABI increased to 0.9 bilaterally

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