AORTOILIAC OCCLUSIVE DISEASE AND GASTROINTESTINAL MALIGNANCY - CHANGING THERAPEUTIC OPTIONS

Treatment of gastrointestinal malignancy encountered unexpectedly duri ng procedures involving the abdominal aorta continues to be debated. P reviously, simultaneous vascular procedures with intraabdominal malign ancy were rare. Most underwent vascular reconstruction followed by a d elayed aortic procedure. With recent improvement in axillobifemoral gr aft patency, a one-stage procedure for aortoiliac disease should be en tertained. We recently encountered a small bowel lymphoma while beginn ing an aortic replacement for aortic occlusion. Resection of a near-ob structing small bowel tumor immediately after axillofemoral reconstruc tion provided treatment of both entities at one time. Since the early description of axillofemoral bypass in 1963,(1,2) varying success with extra-anatomic bypass has been reported. Early data for axillofemoral bypass were dismal, but with recent technical and graft improvements patency has been improved.(3) Occult malignancy during aortic procedur es is uncommon, about 2 to 4 per cent, but when met is usually dealt w ith after the patient recovers from the vascular procedure. With impro vements in extra-anatomic bypass results, a single operative period ca n be entertained.