Rutherford's 110: Aortoiliac Disease: Open Extra ­Anatomic Bypass скачать в хорошем качестве

Rutherford's 110: Aortoiliac Disease: Open Extra ­Anatomic Bypass

#ExtraAnatomicBypass #VascularSurgery #FemFemBypass #AxfemBypass #ObturatorBypass #RutherfordsVascular #HostileAbdomen #ArterialInfection #CLTI #Claudication #DrGregoryWeir This video, based on Rutherford's Vascular Surgery textbook, explores extra-anatomic bypass procedures, alternative surgical routes used when direct arterial reconstruction is not feasible. Developed in the 1950s, these "surgical detours" are used primarily for patients with comorbidities making direct surgery too risky, those with a "hostile abdomen" from previous surgery or infection, or when there's an arterial infection near the main vessels. Preoperative patient optimization and detailed imaging (like CTA or MRA) are crucial before these procedures. While endovascular options are increasingly common, these techniques remain essential for specific, challenging cases. Three main types are discussed: **Femoral-Femoral Bypass (Fem-Fem)**: Connects one leg's healthy iliac system (donor side) across to the other leg (recipient side) with a graft, typically prosthetic. Used classically for unilateral iliac disease, now also with endovascular techniques to improve inflow. The graft is usually tunnelled subcutaneously above the pubic bone. It's a lower-risk option for unilateral disease in higher-risk patients. Patency rates are generally lower than direct aortofemoral bypass but effective for preventing limb loss. **Axillary-Femoral Bypass (Ax-Fem)**: Routes a graft from the axillary artery in the shoulder down to the femoral artery in the groin. Used for severe aortoiliac blockages in high-risk patients, existing aortic graft infection, aortoenteric fistulas, or a hostile abdomen. Grafts are almost always prosthetic and tunnelled subcutaneously along the side. Patency rates are often lower than fem-fem bypasses, but it's a critical tool for specific challenging cases. **Obturator Bypass**: Passes a graft through the obturator foramen in the pelvis to bypass an infected or unusable groin, typically connecting the iliac artery to the popliteal or femoral artery. Due to the high infection risk in the groin, autologous vein is strongly recommended as the graft material. It's a specialized tool for avoiding a compromised groin, particularly useful with increasing femoral artery complications from procedures or drug use. Patency may be lower than standard fem-pop bypasses, but it's vital when needed. All three provide decent blood flow and acceptable long-term patency for selected patients who cannot undergo direct reconstruction. They are essential skills for vascular surgeons dealing with complex problems.