Chapter 47 - Femoral Tibial Bypass

Abstract

Chronic limb-threatening ischemia is a spectrum of peripheral arterial occlusive disease that places an individual at significant risk for major limb amputation. Although advances in endovascular therapy have provided multiple treatment options for infrainguinal arterial occlusive disease, open surgical arterial bypass continues to have the most durable long-term outcomes. This is particularly true when there is chronic limb-threatening ischemia secondary to multilevel arterial disease necessitating that inline arterial flow be provided at the level of a tibial artery. Because chronic limb-threatening ischemia commonly occurs with diseased distal arterial vessels, it is important to have a thorough understanding of how to perform an infrainguinal bypass to various distal arterial targets, including the anterior tibial, posterior tibial, peroneal, and dorsalis pedis arteries using autogenous or nonautogenous conduits. The patient positioning, arterial exposure, and tunneling of these bypasses are critical aspects to ensuring success of the bypass. This chapter provides insight into important considerations with respect to patient positioning and techniques of arterial exposure and control and to bypass tunneling when creating infrainguinal bypasses from the common femoral artery to the anterior tibial, posterior tibial, peroneal, or dorsalis pedis arteries.