A distal bypass or an arterial bypass on a tibial or pedal artery is often needed especially in diabetic patients with critical lower limb ischemia. Generally it is considered a bothersome procedure, where someone needs to try too much, spend a long time with questionable results. Is it so? Well, partly yes, but I feel that it almost always worth a try. Let’s see how to do it.
- Step 1: Target vessel exposure
Start from the recipient site. Based on the preoperative angiogram you must have already a target vessel for the revascularization. Whether it is a tibial or a pedal artery, you need to dissect it first. Just remember, that you do not need to spend too much effort on that. Just a small part of the artery, of about 5cm or less in
Something to remember: avoid to any cost to do an endarterectomy on the distal target vessel. Either you make the anastomosis as it is or abandon.