Infrainguinal arterial bypass

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Revision as of 18:16, 4 April 2022 by Tony Wang (talk | contribs) (Included surgical procedure steps)
Infrainguinal arterial bypass
Anesthesia type

General

Airway

ETT

Lines and access

2 large bore PIVs, arterial line

Monitors

Standard ASA, ABP

Primary anesthetic considerations
Preoperative

Other comorbid conditions including CAD, HTN, DM often present

Intraoperative

Reperfusion after cross clamp may cause acidosis, ATN, hyperkalemia

Postoperative
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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
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References