Types of Vascular Reconstructive Surgery and PostOp Care

Question 1

Aorto-bifemoral Graft

Answer 1

Bypass extends from distal aorta to common femoral arteries. For stenosis of aorta or iliac vessels.
IF there is stenosis or blockage they create a graft that bypasses them. An artificial conduit. Can be made from vessels from your body

Question 2

Femoro-popliteal Bypass

Answer 2

For occlusion in superficial femoral artery. Graft is either a healthy blood vessel or a man-made material

Question 3

Femoro-Distal Bypass

Answer 3

• For stenosis in distal vessels. Preferred to use saphenous vein in severe critical ischemia
• Graft extends from femoral to either peroneal or tibial artery
• Patency rate poorer than femoro-popliteal graft

Question 4

Axillo-bifemoral graft

Answer 4

for aorto-iliac stenosis

Question 5

Femoro-femoral Crossover Graft

Answer 5

For iliac artery occlusion

Question 6

Post-Op Care Following Peripheral Bypass Surgery: Immediate Post-op (7)

Answer 6

Primary Responsibility - early recognition of complications
1. ABC
2. VS - per protocol (q15 min, q30 min &q1h)
3. Peripheral pulses q1h: dorsalis pedis, posterior tibial using a doppler - mark the location loss of pulses, or sudden increase of pain should be reported immediately
4. Observe CWMS: report sudden changes. use a bed-cradle to aid observation, and protect heels
5. Observe wound for bleeding or hematoma formation
6. Sudden increase in output in drainage tube -> rupture of graft anastomosis
7. Any indication of graft occlusion or rupture -> surgical emergency

Question 7

Additional Post-Op considerations (7)

Answer 7

• Analgesia for pain (epidural or PCA) -> for 24-48 hrs or until can take them orally
• Preventative Abx - graft infection
• Monitor U/O - 30ml/h
• IV fluids via central line (CVP line)
• Sliding-scale insulin for diabetic patients
• O2 as prescribed
• Possibility of paralytic ileus in pts with aortic grafts -> stComach should be empty & NG

Question 8

Post-Op care: mobility

Answer 8

• Sit upright, DB &C, gentle leg exercise to prevent chest infection and DVT
• mobility encouraged 1-2 days post-op
• elevate legs to prevent occlusion of grafts behind knee (i.e, femoral to below-knee popliteal graft)

Question 9

Post-op Care VTE prophylaxis and wound care

Answer 9

SC heparin to decrease risk of DVT
- anti-embolic stockings = not unless instructed by the surgeon because they put pressure and could occlude. not recommended for ABI<0.1
- inspect wounds for signs of inflammation (infection)
- sutures removed 12-14 days post-op
- drainage tubes (usually in there around a day)