Femoral Posterior Tibial Bypass with PTFE Graft and Adjunctive AV Fistula

Abstract

Bypasses to infrapopliteal vessels with prosthetic grafts are rarely used. When no other alternative is available and in the absence of an autogenous conduit, such bypasses may be performed as a last resort for limb salvage. Adjunctive procedures have been designed to address poor patency of infrapopliteal prosthetic bypasses, such as the construction of a venous cuff or the creation of an arteriovenous fistula at the distal anastomosis. One procedure combines both a vein cuff and an arteriovenous fistula at the distal anastomosis. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.