Thoracofemoral Bypass: A Retroperitoneal Approach
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Procedure Outline
Table of Contents
- 1. Introduction
- 2. Surgical Approach
- 3. Bilateral Groin Incisions and Femoral Exposure
- 4. Thoracoretroperitoneal Incision and Access to the Retroperitoneum
- 5. Retroperitoneal Dissection and Exposure of the Aorta
- 6. Retroperitoneal Tunnels Over the External Iliacs and Under the Ureters
- 7. Proximal Anastomosis of Graft to Aorta
- 8. Right Distal Anastomosis of Graft to Femoral Artery
- 9. Left Distal Anastomosis of Graft to Femoral Artery
- 10. Final Inspection and Hemostasis
- 11. Closure
- 12. Post-op Remarks
- Ultrasound Evaluation of the Aorta and Branches Before Clamping
- Administration of Mannitol
- Heparinization
- Prepare for Anastomosis
- Occlusion with Side-Biting Clamp
- Aortic Arteriotomy
- Aortic Punch
- Suture Anastomosis
- Repair Microtearing with Pledgeted Sutures
- Test Anastomosis
- Duplex Ultrasonography to Interrogate Anastomosis and Aorta
- Doppler to Interrogate Blood Flow to Viscera
- Flush Graft
- Advance Graft Through Tunnels to Femoral Arteries
- Arteriotomy
- Endarterectomy
- Suture Anastomosis
- Reperfuse Right Leg and Test Anastomosis
- Reperfuse Left Leg, Test Anastomosis, and Confirm Distal Perfusion
- Reversal of Heparin
- Chest Tube
- Diaphragm
- Reapproximation of the Ribs
- Abdominal Wall
- Skin and Soft Tissues in Layers
