Aortic bypass

Aortobifemoral bypass

• IDC, arterial line, antibiotics, consider cellsaver, consider epidural
• Abdominal exposure of aorta, typically by an upper midline. Typically expose aorta between renal arteries and IMA.
• CFA exposures in groin (control of inferior epigastric and circumflex iliacs proximally; control of SFA and PFA distally)
• Develop tunnels posterior to inguinal ligament by blunt finger dissection. Sometimes partially divide inguinal ligament to prevent graft compression. Track tunnels directly anteriorly to EIA, definitely posterior to ureters. Look out for a crossing vein immediately under the IL. Then complete tunnels from above. Left limb tunnel passes under sigmoid mesentery but slightly laterally to avoid nervi erigentes.
• Heparin IV
• Clamp aorta at site of least disease proximally and above IMA distally

Aortobi-iliac bypass

• Indications:
  • Hostile groins (previous operation or radiotherapy)
  • Obese, diabetic patients with intertriginous rashes