Extended deep femoral angioplasty

Abstract

Publisher Summary This chapter discusses the operative procedure extended deep femoral angioplasty. The common, deep, and superficial femoral arteries are dissected free of their femoral sheath and all branches controlled by sling sutures or bulldog clamps. The deep femoral vein is transfixed, tied, and divided between silk sutures. The deep femoral artery is dissected free of surrounding tissues as far as necessary until a soft disease-free segment of artery is reached. This may extend as far as the third or fourth perforating muscular branch. The saphenous nerve is carefully retracted to avoid a painful saphenous neuritis around the inner side of the knee postoperatively. It is found that if the deep femoral artery arises from the common femoral artery more proximally than usual, the lower edge of the inguinal ligament must be notched but not divided. Division carries a high incidence of hernia, which is extremely difficult to repair as the femoral artery forms part of the posterior wall of the hernia. Tiny cuts are made transversely at each end of the arteriotomy so that the ends of the sewn-in patch will be square, not tapered, thus avoiding any tendency to stenosis, which is particularly possible at the distal end.