Pedal bypass surgery is a highly demanding procedure with a strong possibility of instant failure and graft thrombosis. Stick adhesion to details may be useful for a favourite outcome. There follow some of my thoughts describing the way to go. Follow these steps and be a winner.
Tips
- Vein graft of good quality (diameter > 3 mm)
- Non-reversed graft configuration
- Careful valvulotomy (maximum 2 passages)
- Superficial route of the graft (personal preference the ScanlanTM tunneller)
- Distal anastomosis without clamps
- Parachute technique for the anastomoses
- Make one or two skin incisions parallel to the incision for the pedal artery, leaving them unsutured like fasciotomies at the end of the procedure. This approach reduces the risk of dehiscence in the skin incision over the pedal artery compared to performing the procedure without these additional fasciotomies. (updated 4/1/2025)
Necessities
- Magnification (at least 3.5x)
- Head lighting
- Small instruments (Castro needle holder, ring forceps)