Chapter 107 - Aortoiliac disease open extraanatomic bypass Flashcards
When was FEM-FEM first described
1952
Evidence on superiority of femfem bypass graft material
no evidence that any is better than the other
Operative mortality of fem-fem
< 5%
Patency of fem-fem
70% 5 years
Primary indications for axillofemoral bypass
1) symptomatic aortoiliac occlusive disease with excessive high risk for direct repair
2) infected aorta or aortic graft
3) hostile abdomen
Reasons to choose side in ax-fem bypass
1) need for thoracotomy or abdominal surgery later
2) patency of the inflow artery
3) presence of stomas
4) side to sleep on (controversial)
5) not on arm with AVF (theoretical only)
6) side with higher BP if > 10 mm Hg difference
Reason to abduct arm for ax-bifem
1) better visualization of ipsilateral chest
2) easier tunnelling
3) elevates clavicle
4) minimize graft pull out
Ways to minimize pullout of ax-fem grafts
1) as medial as possible on axillary artery
2) leave some redundancy
ABI after ABF vs AxBF in normal infrainguinal vessels
ABF > 1.0
AxBF < 0.7
Patency of AxBF
5 years 60-70%
highly variable in literature
Who first described obturator bypass
Shaw and Baue 1963
Indication for obturator bypass
Hostile groin, infection
How to approach the obturator foramen
1) Posterior to adductor longus
2) Approach medial to EIV
3) posterior to superior aspect of pubic ramus
4) dissect away obturator internus from membrane
5) Incision made in anteromedial part of obturator membrane
How to tunnel after the obturator foramen
Usually between adductor magnus posteriorly and adductor longus and brevis anteriorly
alternatively tunnel between adductor longus and brevis to bring to SFA
Patency of obturator bypass
primary patency 50-60% 5 years
