Exposures
This is the exposure for CFA.
These are the two indications for infrainguinal intervention.
Claudication and Chronic Limb threatening ischemia
this is the ideal conduit for infrainguinal bypasses
autogenous vein.
These are the four options for completion assessment that can be used alone or in combination.
1. distal pulse palpation and Doppler flow assessment
2. completion arteriography
3. intraoperative duplex scanning
4. angioscopy
Major wound complications are seen in this percentage of infrainguinal bypasses.
5%
Lateral Exposure for peroneal artery.
This is the minimal ideal diameter for GSV being used as bypass conduit.
3mm
these are the most commonly used autogenous conduit options. (5)
GSV, LSV, UE veins, deep femoral/popliteal vein, radial artery
Name the technical defect identified on this completion angiogram.
Tunnel compression of the graft, corrected by further dissecting the bypass tunnel.
Name 3 late bypass complications.
Graft thrombosis, stenosis, infection. Lymphedema.
The SFA lies in a plane deep to this muscle.
Sartorius
These are your inflow choices for infrainguinal bypass.
Common Femoral, Profunda, SFA, popliteal or tibial arteries
This is the proposed benefit of in-situ vein conduit.
Vein-artery size match
Serial surveillance studies should be performed this often within the first year.
Every 3 months for a year. Then every 6 months for 2 additional years. Then every year.
What is the best way to prevent late post-op graft occlusion?
Regular DUS surveillance as an outpatient.
For the obturator bypass - grafts should be tunneled in this orientation through the obturator membrane in order to avoid injury to the obturator artery and nerve.
Grafts should be tunneled through the anterior medial portion of the membrane to avoid injury to the obturator artery and nerve, which pass through its posterior lateral portion.
True or false: The orientation of the vein conduit affects bypass patency. (R=reversed, non-reversed, or in-situ)
False, all perform equally well.
For bypasses that insert below the knee - this technique confers improved patency.
Vein cuff (Miller Cuff, Taylor Patch, St. Marys Boot).
patency 52% vs 30% at 2 years with vein cuff
Grafts with focal lesions associated with a peak systolic velocity greater than this ___, are treated with prophylactic repair to prevent significant graft stenosis.
300 cm/s
This is the cause of bypass stenosis within 1-2 years of implantation.
Intimal hyperplasia.
This approach to the popliteal artery in situation of infection or prior failed bypasses.
Posterior approach
This target is useful in patients with limited tibial runoff but should only be used in patients with claudication, and not tissue loss.
A blind, or isolated, popliteal artery = defined as a patent popliteal artery segment at least 5 cm long but with only geniculate collaterals and no major distal tibial or peroneal runoff artery in direct continuity with the foot
This open technique can be used above the knee if vein length is an issue and a more distal inflow anastomosis is required.
Grafts that develop low-flow velocities, less than ____ PSV, over time or a drop in ankle-brachial index exceeding ____ undergo arteriography to search for inflow, outflow, or missed graft lesions.
<45 cm/s
0.15
This post-operative medical management confers some patency benefit but doubles the patients risk of bleeding complications.
Post-op anticoagulation.
Post-op aspirin has been shown to improve graft patency in european studies and vein patency in the US with no increase in bleeding complications.