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Fem-distal Bypass Josh Wilensky
1. Preop <ul><li>Arteriogram </li></ul><ul><li>Vein mapping </li></ul>
2. Inflow Dissection <ul><li>Vertical incision over femoral pulse </li></ul><ul><li>CFA, PFA, SFA circumferentially dissec...
Inflow Dissection
3. Outflow Dissection
3. Outflow Dissection
4. Vein Harvest <ul><li>Ipsilateral GSV with skip incisions </li></ul><ul><li>Distended with heparinized saline </li></ul>...
5. Tunneling <ul><li>- Anatomic location  </li></ul><ul><li>umbilical tape is left in the tunnel </li></ul><ul><li>distal ...
6. Heparin <ul><li>10,000 units of heparin </li></ul>
7. Anastomosis <ul><li>Proximal: 6-0 running prolene end-to-side </li></ul><ul><li>Distal: 7-0 interrupted prolene end-to-...
8. Arteriogram <ul><li>Check feet for pulses and signals </li></ul><ul><li>Completion arteriogram </li></ul><ul><ul><li>Ca...
9. Wound Closure <ul><li>Wounds closed in layers with 3-0 vicryl </li></ul><ul><li>Skin with staples </li></ul>
10. Post op <ul><li>Staples out in 2 weeks </li></ul><ul><li>ABIs in 6 weeks </li></ul><ul><li>Q 6mo ABIs </li></ul>
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Fem distal bypass

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  • Double looped, heiphitz on PFA
  • lower leg medial incision made approximately 1 cm below the medial border of the tibia . the medial head of the gastrocnemius as well as the soleus muscle are identified and retracted posteromedially
  • The anterior tibial artery is exposed through a lateral skin incision made halfway between the lateral edge of the tibia and the fibula. The subcutaneous tissue and fascia are incised and the intramuscular septum between the tibialis anterior muscle medially and the extensor digitorum longus muscle laterally is located and incised
  • A: Medial tunnel from common femoral artery to posterior tibial artery B: Lateral tunnel from common femoral artery to anterior tibial artery.
  • Incorporation of distal branch
  • Transcript of "Fem distal bypass"

    1. 1. Fem-distal Bypass Josh Wilensky
    2. 2. 1. Preop <ul><li>Arteriogram </li></ul><ul><li>Vein mapping </li></ul>
    3. 3. 2. Inflow Dissection <ul><li>Vertical incision over femoral pulse </li></ul><ul><li>CFA, PFA, SFA circumferentially dissected out with vessel loops </li></ul><ul><ul><li>PFA dissected to bifurcation/trifurcation </li></ul></ul><ul><ul><li>Crossing veins of PFA ligated </li></ul></ul>
    4. 4. Inflow Dissection
    5. 5. 3. Outflow Dissection
    6. 6. 3. Outflow Dissection
    7. 7. 4. Vein Harvest <ul><li>Ipsilateral GSV with skip incisions </li></ul><ul><li>Distended with heparinized saline </li></ul><ul><li>Side branches ligated with 4-0 silk </li></ul><ul><li>Reversed vs Non-reversed </li></ul><ul><ul><li>Non-reversed – better size match </li></ul></ul>
    8. 8. 5. Tunneling <ul><li>- Anatomic location </li></ul><ul><li>umbilical tape is left in the tunnel </li></ul><ul><li>distal end of the vein is tied with a 2–0 silk tie to the tunneling device and passed back through the previously made tunnel </li></ul>
    9. 9. 6. Heparin <ul><li>10,000 units of heparin </li></ul>
    10. 10. 7. Anastomosis <ul><li>Proximal: 6-0 running prolene end-to-side </li></ul><ul><li>Distal: 7-0 interrupted prolene end-to-side </li></ul>
    11. 11. 8. Arteriogram <ul><li>Check feet for pulses and signals </li></ul><ul><li>Completion arteriogram </li></ul><ul><ul><li>Cannulate CFA with 20-gauge butterfly needle </li></ul></ul>
    12. 12. 9. Wound Closure <ul><li>Wounds closed in layers with 3-0 vicryl </li></ul><ul><li>Skin with staples </li></ul>
    13. 13. 10. Post op <ul><li>Staples out in 2 weeks </li></ul><ul><li>ABIs in 6 weeks </li></ul><ul><li>Q 6mo ABIs </li></ul>
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