Master Techniques in Surgery: Vascular Surgery: Arterial Procedures by Darling R. Clement;Ozaki C. Keith;

Author:Darling, R. Clement;Ozaki, C. Keith; [Darling III, R. Clement; Ozaki, C. Keith]
Language: eng
Format: epub
ISBN: 4786265
Publisher: Wolters Kluwer
Published: 2016-09-15T00:00:00+00:00

24 Femoropopliteal Bypass Using Prosthetic and Vein

Neal Barshes

INDICATIONS/CONTRAINDICATIONS

The accepted indications for revascularization in the setting of femoropopliteal segment occlusive disease remain the same as they have been for decades, namely femoropopliteal disease associated with: (1) nonhealing foot wound (including foot ulcer or gangrene), (2) foot or leg pain at rest that appears to be due to an ischemic etiology, or (3) severe claudication that is both limiting in one’s daily activities and recalcitrant to supervised exercise regimen. In most contemporary vascular surgical practices, an attempt at endovascular intervention is usually the first-line option for patients meeting the above criteria, and surgical bypass is reserved for cases that cannot be successfully treated with percutaneous endovascular techniques. Proceeding directly to open surgical bypass is a perfectly valid treatment option, however, in cases that are unlikely to have an effective or durable response to endovascular intervention—for example, young patients with long-segment occlusion of the superficial femoral artery, good-caliber ipsilateral saphenous vein, and debilitating claudication. So, although the indications for revascularization have remained unchanged, the ultimate decision between endovascular intervention and femoropopliteal bypass requires judgment based on both the clinical situation and one’s own technical experience and expertise.

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