Difference between revisions of "Infrainguinal arterial bypass"
From WikiAnesthesia
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Chris Rishel (talk | contribs) m |
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| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = | | lines_access = Large bore IV x2 | ||
| monitors = Standard | Art line | ||
| considerations_preoperative = | | monitors = Standard | ||
| considerations_intraoperative = Ischemia-reperfusion syndrome after cross clamp removal | ABP | ||
| considerations_preoperative = Evaluate for CAD, HTN, DM | |||
| considerations_intraoperative = Ischemia-reperfusion syndrome after cross clamp removal | |||
*Lactic acidosis | |||
*ATN | |||
*Hyperkalemia | |||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
Infrainguinal arterial bypass procedures include: | '''Infrainguinal arterial bypass''' procedures include: | ||
* Aortofemoral bypass or aortobifemoral bypass | * Aortofemoral bypass or aortobifemoral bypass | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:Vascular surgery]] |
Revision as of 01:04, 5 April 2022
Infrainguinal arterial bypass
Anesthesia type |
General |
---|---|
Airway |
ETT |
Lines and access |
Large bore IV x2 Art line |
Monitors |
Standard ABP |
Primary anesthetic considerations | |
Preoperative |
Evaluate for CAD, HTN, DM |
Intraoperative |
Ischemia-reperfusion syndrome after cross clamp removal
|
Postoperative | |
Article quality | |
Editor rating | |
User likes | 0 |
Infrainguinal arterial bypass procedures include:
- Aortofemoral bypass or aortobifemoral bypass
- Axillofemoral bypass or axillobifemoral bypass
- Femorofemoral bypass (fem-fem)
- Femoral popliteal bypass (fem-pop)
- Femoral tibial bypass (fem-tib)
Overview
Indications
Severely PAD causing claudication, ulceration, or infection
Surgical procedure
- Incision of bypass sites (source and target arteries)
- ± Harvest of vein graft
- Anastomotic tunnel creation
- Clamp of proximal artery
- Distal anastomosis, then proximal anastomosis
- Reperfusion of arteries
- Arteriogram to confirm flow
Preoperative management
Patient evaluation
System | Considerations |
---|---|
Airway | |
Neurologic | Peripheral neuropathy |
Cardiovascular | Significant PAD, usually also CAD (prior MIs), HTN |
Pulmonary | |
Gastrointestinal | |
Hematologic | |
Renal | Possible comorbid CKD |
Endocrine | Usually DM |
Other |
Labs and studies
- BMP to evaluate potassium, creatinine
- Coagulation factors (INR, PTT)
Operating room setup
- Arterial line setup
- Lead for intraop arteriogram
- Heparin and protamine prepared for clamp/unclamping
Patient preparation and premedication
- Anxiolysis as indicated
Regional and neuraxial techniques
- Spinal or epidural can be considered for intraoperative and postoperative pain control
- There is some evidence that regional anesthesia promotes graft survival [citation needed].
Intraoperative management
Monitoring and access
- 2 large bore IVs for possible fluid/product resuscitation
- Arterial line for ABP
Induction and airway management
General anesthesia with ETT. Induce with paralysis
Positioning
- Supine
Maintenance and surgical considerations
- Clamping of large arteries may produce afterload increase, though usually minimal effect
- Unclamping of large arteries may induce ischemia-reperfusion syndrome (lactic acidosis, hyperkalemia, ATN)
- Heparin is needed during anastomosis creation
- Protamine may be needed for reversal at end of case
Emergence
Postoperative management
Disposition
IMC vs. ICU
Pain management
If regional anesthetic used, epidural may be redosed.
Potential complications
- Arterial thrombosis/occlusion
- Acute cardiac event
- Wound hematoma
- Compartment syndrome
Procedure variants
Variant 1 | Variant 2 | |
---|---|---|
Unique considerations | ||
Position | ||
Surgical time | ||
EBL | ||
Postoperative disposition | ||
Pain management | ||
Potential complications |
References
Top contributors: Tony Wang, Jashvin Patel and Chris Rishel