Femoral Artery Cut-Down and Proximal Anastomosis Procedure (Cadaver)
Adrian Estrada1; Adam Tanious, MD2; Samuel Schwartz, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital
Femoral-to-popliteal/distal bypass surgery is a procedure used to treat femoral artery disease. It is performed to bypass the narrowed or blocked portion of the main artery of the leg, redirecting blood through either a transplanted healthy blood vessel or through a man-made graft material. This vessel or graft is sewn above and below the diseased artery such that blood flows through the new vessel or graft. The bypass material used can be either the great saphenous vein from the same leg or a synthetic polytetrafluoroethylene (PTFE) or Dacron graft.
This procedure is recommended for patients with peripheral vascular disease for whom medical management has not improved symptoms, for those with leg pain at rest that interferes with quality of life and ability to work, for non-healing wounds, and for infections or gangrene of the leg where there is a danger of loss of limb caused by decreased blood flow. This article demonstrates how to perform femoral artery cut-down and proximal anastomosis procedure in a cadaver. This procedure is commonly used when performing a femoral-popliteal below the knee bypass to restore blood flow to areas affected by arterial blockages or injuries․
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Ory Wiesel, MD; Marco Zenati, MD
VA Boston Healthcare System
Minimally invasive direct coronary artery bypass (MIDCAB) utilizes a small (4–5 cm) left anterior thoracotomy incision for direct visualization of the diseased coronary artery on the anterior wall of the left ventricle without the use of cardiopulmonary bypass (CPB).
This article describes the basics of the MIDCAB surgery, emphasizing both the left anterior thoracotomy for the harvest of LIMA and direct anastomosis on a beating heart without CPB. This procedure is done on a 72-year-old patient who had significant long LAD stenosis and presented with effort angina. Following a multidisciplinary “heart team” conference, he underwent a successful MIDCAB and was discharged home on postoperative day 4.
Thoracofemoral Bypass: A Retroperitoneal Approach
J. Miller Allan, MD; Victoria Aucoin, MD; Benjamin J. Pearce, MD
UAB Hospital
Surgical intervention for aortoiliac occlusive disease (AIOD) remains a vital tool in the management of AIOD. AIOD is caused by occlusion of the infrarenal and/or iliac arteries, often secondary to atherosclerosis. This article presents a case of a young, male patient with a history of familial hyperlipidemia and chronic tobacco use who underwent a thoracofemoral bypass (TFB) procedure via a retroperitoneal approach.
He presented with classic symptoms of bilateral leg pain when walking, nocturnal lower extremity pain, and correlated diminished lower extremity pulses. TFB was the preferred approach due to the aggressive, soft plaque burden extending into the suprarenal aorta, which precluded endovascular repair and would have increased risk for standard infrarenal aortofemoral bypass (AFB). This video and case report present a detailed explanation of a retroperitoneal approach to a TFB procedure.
Thoracoabdominal Aortic Aneurysm Repair – Part 2
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery
Massachusetts General Hospital
Dr. Patel continues repairs on this thoracoabdominal aortic aneurysm in Part 2 of this two part series. Watch as he works against the clock during visceral ischemia time until blood flow from the graft is restored to all the dependent organs! (Pre-print, Part 2 of 2).
This article follows a previously released Part 1.
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