Infrainguinal arterial bypass

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

Procedure variants

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