Vascular

Aortobifemoral Bypass

OPERATION: Aortobifemoral Bypass
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV antibiotics at induction (prosthetic graft)
POSITION: Supine, abdomen and both groins prepared. Laminar flow theatre preferred.

INDICATION:
Severe diffuse iliac occlusive disease or distal aortic occlusion not amenable to endovascular intervention. Preoperative CT angiography reviewed. Bifurcated graft sizes confirmed available.

PROCEDURE:
WHO Checklist performed.

FEMORAL EXPOSURE (performed first):
Vertical groin incisions bilaterally. Common femoral, superficial femoral, and profunda arteries dissected and slung. Dissection extended proximally to inguinal ligament; lower ligament divided if external iliac exposure required.

PROXIMAL EXPOSURE:
Midline / transverse laparotomy. Small intestine reflected to the right. Retroperitoneum dissected. Inferior mesenteric vein retracted laterally or ligated. Aorta dissected infrarenally — dissection kept away from bifurcation to avoid pelvic parasympathetic nerve injury. Heparin 5000 IU IV administered.

PROXIMAL ANASTOMOSIS: