1. (A) This drawing illustrates axillobifemoral bypass, with a distal extension to the popliteal artery. This patient had severe ischemic change in right lower extremity with ischemic lesions and severe claudication. Both extremities were disabling. An angiogram confirmed complete occlusion of the infrarenal aorta and bilateral iliac artery system, with an obstruction of the right SFA. Left common femoral artery anastomosis was made with an 8-mm PTFE graft (double arrows). The graft was then passed through the tunnel to the right common femoral artery in side-to-side fashion (double open triangle). A side-to-side anastomosis was made between the PTFE graft and the right common femoral artery. Then the same PTFE graft was extended further by anastomosing a new 6-mm PTFE graft at point C. When this anastomosis is done between 8-mm and 6-mm PTFE grafts, the anastomosis was made after appropriate spatulation to minimize the size mismatch (black triangle arrow). The new 6-mm PTFE graft was extended down to the right above knee popliteal artery for distal anastomosis (D*). The left axillofemoral artery bypass graft was shown as A (arrow). (B) On the same patient, end-to-side anastomosis between the descending limb of the left axillofemoral artery bypass graft (arrow), and left femoral–right femoral artery bypass graft (double arrow). (C) Operative picture of the same patient at the distal anastomosis between the 6-mm PTFE graft and above-knee left popliteal artery (arrows). The patient's head is on the right side.
Source: Lower Extremity Revascularization for Atherosclerotic Occlusive Disease, Peripheral Arterial Disease
Citation: Dieter RS, Dieter RA, Jr., Dieter RA, III. Peripheral Arterial Disease; 2016 Available at: Accessed: January 23, 2018
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