Fem-distal BypassFem-distal Bypass

Josh WilenskyJosh Wilensky

1. Preop1. Preop

ArteriogramArteriogramVein mappingVein mapping

2. Inflow Dissection2. Inflow Dissection

Vertical incision over femoral pulseVertical incision over femoral pulseCFA, PFA, SFA circumferentially CFA, PFA, SFA circumferentially

dissected out with vessel loopsdissected out with vessel loopsPFA dissected to bifurcation/trifurcationPFA dissected to bifurcation/trifurcationCrossing veins of PFA ligatedCrossing veins of PFA ligated

Inflow DissectionInflow Dissection

3. Outflow Dissection3. Outflow Dissection

3. Outflow Dissection3. Outflow Dissection

4. Vein Harvest4. Vein Harvest

Ipsilateral GSV with skip incisionsIpsilateral GSV with skip incisionsDistended with heparinized salineDistended with heparinized salineSide branches ligated with 4-0 silkSide branches ligated with 4-0 silkReversed vs Non-reversedReversed vs Non-reversed

Non-reversed – better size matchNon-reversed – better size match

5. Tunneling5. Tunneling

- Anatomic location

-umbilical tape is left in the tunnel

-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

6. Heparin6. Heparin

10,000 units of heparin10,000 units of heparin

7. Anastomosis7. Anastomosis

Proximal: 6-0 running prolene end-to-sideProximal: 6-0 running prolene end-to-side

Distal: 7-0 interrupted prolene end-to-sideDistal: 7-0 interrupted prolene end-to-side

8. Arteriogram8. Arteriogram

Check feet for pulses and signalsCheck feet for pulses and signalsCompletion arteriogramCompletion arteriogram

Cannulate CFA with 20-gauge butterfly needle Cannulate CFA with 20-gauge butterfly needle

9. Wound Closure9. Wound Closure

Wounds closed in layers with 3-0 vicrylWounds closed in layers with 3-0 vicrylSkin with staplesSkin with staples

10. Post op10. Post op

Staples out in 2 weeksStaples out in 2 weeksABIs in 6 weeksABIs in 6 weeksQ 6mo ABIsQ 6mo ABIs