# Total venous coronary artery bypass grafting for acute myocardial infarction with Leriche syndrome and porcelain aorta: a case report

## TL;DR

A patient with heart failure and Leriche syndrome underwent a specific type of heart surgery to preserve blood flow to the legs.

## Contribution

The paper presents a case report of on-pump total venous CABG in a patient with Leriche syndrome and acute myocardial infarction.

## Key findings

- On-pump total venous CABG was successfully used to preserve lower limb perfusion in a patient with Leriche syndrome.
- This approach is a reasonable option for coronary revascularization in patients with IHD complicated by Leriche syndrome.
- Mechanical circulatory support devices are challenging to use in such cases due to occlusive disease.

## Abstract

Leriche syndrome is an occlusive disease involving the abdominal aorta and iliac arteries that is frequently associated with ischemic heart disease (IHD). The internal thoracic arteries in patients with Leriche syndrome often serve as important collateral pathways to the lower extremities. Therefore, graft selection for coronary artery bypass grafting (CABG) requires special consideration. We performed on-pump total venous CABG in a patient with acute heart failure secondary to IHD complicated by Leriche syndrome who required emergent coronary revascularization. This strategy was chosen to preserve lower limb perfusion. When coronary revascularization is a priority for patients with IHD complicated by Leriche syndrome, on-pump total venous CABG is a reasonable option because of the need to preserve lower limb perfusion and difficulty of using mechanical circulatory support devices for occlusive disease.