Operative Note |
PROCEDURE: Left femoral to above-knee popliteal artery bypass utilizing a 7 mm ring reinforced PTFE Distaflo Graft. |
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SUMMARY: The patient was taken to the operating room. After adequate induction of general endotracheal anesthesia,
the abdomen and left lower extremity was sterilely prepped and draped in the usual manner. An oblique left groin incision was
made in the underlying subcutaneous tissues were divided using electrocautery. The common femoral artery was then dissected
free from its surrounding structures, as the inguinal ligament was mobilized. The distal external iliac artery was also dissected
free from surrounding structures. There was some posterior plaquing. However, the vessel appeared overall soft. The distal external iliac and distal common femoral artery was then encircled with vessel loops. Through a distal left medial thigh
incision, the above-the-knee popliteal artery was exposed and encircled with vessel loops. A subsartorial tunnel was created
and the patient was administered 5000 units of intravenous heparin. The activated clotting times were monitored during the procedure. Proximal distal control of the above-the-knee popliteal artery was achieved and then a longitudinal arteriotomy was made with an 11
blade scalpel. This was extended proximally and distally with Potts scissors. A 4 mm and 5 mm vessel dilator easily passed
through the lumen of the above-the-knee popliteal artery. The distal anastomosis was first created utilizing a running HS7 Prolene
suture, secured with horizontal mattress sutures at the heel and the tail of the anastomosis. Once this anastomosis was complete,
the graft was passed through the tunnel and the attention was turned to the left groin. Proximal and distal left common femoral
artery control was established. Longitudinal arteriotomy was then made, and the graft was tailored to an appropriate length
for spatulated end-to-side anastomosis utilizing a running HS7 Prolene suture. Once the proximal anastomosis is complete, arterial
flow was first reestablished to the distal common femoral artery followed by the graft. The Doppler was used to confirm good
arterial flow signals within the common femoral artery as well as the above-the-knee popliteal artery and the posterior tibia and
dorsalis pedis arteries. Hemostasis was achieved with hemostatic Weck clips and thrombin soaked Gelfoam. The wounds were
then irrigated with antibiotic irrigation and then closed in multiple layers using interrupted 2-0 and 3-0 Vicryl sutures. The
skin was reapproximated with staples. A sterile dressing was then applied. The patient tolerated the procedure well and
was extubated and transported to the recovery room in stable condition.
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