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Blood vessel grafts often come from the same leg of the bypass site, which are arteries above and below the knee. These grafts can only be removed and prepared during surgery at the time of the bypass. However, in some cases a leg vein is left in place and connected to the artery (in situ procedure).
In the legs, bypass grafting is used to treat peripheral vascular disease, acute limb ischemia, aneurysms and trauma.While there are many anatomical arrangements for vascular bypass grafts in the lower extremities depending on the location of the disease, the principle is the same: to restore blood flow to an area without normal flow.
Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of cardiopulmonary bypass by placement of an aortic cannula (bottom of image). The perfusionist and heart-lung machine are on the upper right. The patient's head (not seen) is at the bottom.
Coronary artery bypass graft surgery has been in practice since the 1960s. Historically, vessels—such as the great saphenous vein in the leg or the radial artery in the arm—were obtained using a traditional "open" procedure that required a single, long incision from groin to ankle, or a "bridging" technique that used three or four smaller incisions.
A valvulotome is a catheter-based controllable surgical instrument used for cutting or disabling the venous valves. [1] This is needed to enable an in situ bypass in patients with an occluded artery (especially femoral artery), where the saphenous vein is disconnected from the venous system and connected to arteries above and below the occluded segment to allow blood to flow to the lower leg.
Nonthrombotic iliac vein lesions (NIVL) include May-Thurner Syndrome (MTS) whereby there is compression of the left iliac venous outflow usually by the right iliac artery leading to left leg discomfort, pain, swelling and varicose veins. NIVL encompasses compression of the iliac veins on either the right or left side. [25]
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The bypass versus angioplasty in a study of severe ischemia of the leg investigated infrainguinal bypass surgery first compared to angioplasty first in select patients with severe lower limb ischemia who were candidates for either procedure. In this study, angioplasty was associated with less short term morbidity compared with bypass surgery ...
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