Complex Aortic Surgery

A kidney transplant patient came back to the University of Maryland Medical Center 10 years after his transplant because of complications from of an earlier aortic aneurysm bypass operation. He came to UMMC with kidney failure after local doctors told him there were no more surgical options and he would have to spend his life on dialysis. Fortunately, doctors at UMMC were able to help him by performing an Aorto-Bifemoral Bypass, a type of complex aortic surgery only performed at certain medical centers. Dr. Rajabrata Sarkar, chief of vascular surgery at the University of Maryland Medical Center, answers questions about this special type of surgery below.

What is a complex aortic surgery?

Complex aortic surgery encompasses a number of different operations that are used for people who have poor blood flow to their intestines, kidneys or to their lower extremities. We also do complex aortic surgery when there are aneurysms involving parts of the aorta that we cannot fix by other minimally invasive means. That's when we have to start thinking about more complicated operations.

In what cases would this procedure be used?

This type of surgery would be done in cases in which blood flow needs to be restored to the intestines, kidneys, transplant kidneys and the lower half of the body. It's usually a complicated case in which the patient has been operated on a couple of times and other vascular surgeons may have determined that the surgery is too challenging to do.

How is the aorto-bifemoral bypass graft done?

An aorto-bifemoral bypass graft is done by connecting a synthetic graft to the aorta in the abdomen and then to each femoral artery in the groin. The graft has to be connected to the healthy aorta above the blockage, and similarly the femoral ends of the graft have to go beyond the blockages in each groin.

How often is something like this done at UMMC?

At UMMC, we do complicated aortic surgery once or twice a month. Since I've come to UMMC, I think I've seen an increase in these cases here. I think we will continue to see the volume increase here from more than a couple of cases per month.

Can these procedures sometimes be performed using a minimally invasive approach?

In general, complex aortic surgery is done through traditional open surgery, but we are beginning to implement some minimally invasive programs. We have a very innovative program to treat aortic trans-sections from trauma using a minimally invasive approach that involves putting in a stent graft. You are going to see more of those programs in our division. You're going to see more minimally invasive approaches here at UMMC for aortic aneurysms and aortic dissection, but for some cases, open repair is best.

What do you find rewarding about vascular surgery?

It makes me feel great to help our patients. When we have a patient who can't walk because he doesn't have blood flow to his legs and he's on dialysis, and we do a single operation that corrects both of those problems and he leaves this medical center without needing to return to dialysis, it's really heartwarming. 

Why Come to UMMC?

Patients should come to UMMC because those problems that other medical centers label as too complex and rare are actually quite routine for us and our team. When you come to an academic medical center like UMMC for vascular surgery, you come because we take on the challenges and we have the support -- in terms of anesthesia, ICU and the blood bank -- for the most complicated cases. When complicated problems are tackled regularly, they become less complicated, because we know that if a medical center performs a specific surgery on a regular basis, it will have better results.

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