Need to know details of a "Fem Fem" Bypass for Medical Research Paper?

Can someone please help! I need to know what a Fem Fem Bypass surgery consists of (prep, draping sequence, anesthesia, patient positioning) in order to teach my fellow students about it in our lab class. Any information will be greatly appreciated! And for the record, I have done a TON of web searching to no avail. So hopefully someone can answer these questions who has experience with it. And I will site your answer, thanks!

Need to know details of a "Fem Fem" Bypass for Medical Research Paper?
I can help with the anesthesia part a bit.





Because the surgery is done on the lower half of the body, it can be done under general or regional anesthesia. These are usually done under general, because most vascular surgeons take so freakin' long to do them, and people get too squirmy with a regional block.





Some of the things we are concerned with anesthesia wise: all of these patinets are vasculopaths - their arteries are garbage. The arteries in their legs are no different than the arteries in their hearts and brains, so we expect a higher incidence of heart attack and stroke, and have to take measures to prevent that.





Pre-operative testing is essential to make sure that the heart doesn't have to be fixed first, and that the coronary artery disease that they have is optimally managed. Blood pressure control is also important, because if they are uncontrolled pre-op, they are going to be a nightmare to control intra-op.





Maintaining a semi-normal blood pressure can be a challenge. Some patients run high, and have to be medicated to bring the pressure down. Others (more common, in my experience) tend to drop their pressures and need BP support, sometimes with a phenylephrine drip.





If they expect a lot of blood loss, a cell-saver might be available. Sometimes, we have to transfuse these patients, especially if they start out with a low hct and have bad coronaries.





Positioning is easy - they're supine. Most are intubated and ventilated, but paralysis isn't usually needed (unless they're smokers, and they try to hack the tube out of their sensitive tracheas). Almost all of these patients are or were smokers.





This is just one of the many procedures that these patients have. The same patient will likely return for a fem-pop, and then the amputations start - transmetatarsal, BKA, AKA. It's just a matter of time.





Skin prep is usually nipples to knees, in case the surgeon has to go higher up in the belly and involve the aorta in the procedure. Everybody drapes a little differently, but they tend to put sterile impervious bag type drapes over the feet, and secure them with Coban. The rest of the field is draped out with towels, and probably a big lap drape.





Here are a few articles:


http://www.emedicine.com/med/topic2759.h...


http://www.jcn.co.uk/journal.asp?MonthNu...


http://www.nlm.nih.gov/medlineplus/tutor...





Hope that helps.
Reply:And some info from the other side of the drape...





A fem-fem is done when one of the patient's iliac arteries is occluded. Cutdowns are performed in both groins. A Gore-Tex (or PTFE, similar stuff) is then tunneled through the tissue of the lower abdomen. It usually connects one common femoral artery (CFA) to the one on the opposite side. Each end is sown to an opening that has been made into the CFA. Once flow is established, then a Doppler is often used to verify blood blow at the ankle on the "bad side".


If all is well, the cutdowns are closed. All in all, a fairly "simple" surgery.





Or not. As the anesthesiologist stated, many vascular patients are really sick. Bad hearts, lungs, etc. Getting them through the case alive requires a team effort.

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