When is this procedure indicated?
It is indicated when the atherosclerotic disease is so advanced as to cause pain at rest in the lower (or upper) limbs, ulcerative and/or trophic lesions poorly responsive to medical therapy, claudication intermittens with narrow free walking interval.
How is it performed?
Two incisions are generally made, at the donor and recipient sites. A classic example is the femoro-popliteal bypass in a patient with a multi-stenotic/occluded superficial femoral artery. An inguinal incision is made, the common, superficial, and deep femoral artery are isolated; then an incision is made at the distal medial III of the thigh, and the popliteal artery is isolated. Through a biocompatible prosthesis or vein (auto/heterologous) the proximal (from common femoral artery, donor) and distal (in popliteal artery, recipient) anastomoses are made. At the end of the procedure, the correct patency of the bypass and packing of the anastomoses is checked.
Generally the hospitalization regime is 4-5 days.
Bypass occlusion and/or thrombosis, distal embolization.
Dehiscence, restenosis, bypass occlusion, infection.