Consent: Axillofemoral Bypass - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure A axillo-bifemoral/femoral bypass is typically undertaken when there is significant aortic occlusion or bilateral iliac occlusion in a patient not fit or suitable for aortic surgery. It involves dissection of the axillary artery as well as the common femoral arteries. These are slung and clamped where the artery becomes healthy again, with the artery opened longitudinally and a graft, tunnelled superficially between the incision, is anastomosed. The Korean Society for Thoracic and Cardiovascular Surgery [CC-BY-NC 3.0] Fig 1Axillofemoral bypass. (A) Preoperative CT showing marked irregular narrowing of the descending thoracic and abdominal aorta. (B) Postoperative CT showing a patent axillofemoral bypass graft. Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage This can occur due to damage to either the artery or the femoral vein or its branches, and may require blood transfusion(s). Injury to surrounding structures including The femoral artery lies between the femoral nerve and femoral vein. Either of these can be damaged during the dissection if not careful. Likewise the axillary vein can be damaged during axillary artery dissection. Dissect using a standard approach with identification of the inguinal ligament primarily, then approach the artery proximally Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain The patient will most likely have an epidural anaesthetic to minimise this or use of local anaesthesia during the procedure. Bleeding There is a small chance of bleeding and bruising in the groin or axilla post-operatively. Infection Superficial wound infection is possible, most common in the groin. A graft or patch infection if occurs is a major complication requiring life-long antibiotics. Peri-operative antibiotics will reduce the risk of wound and graft infections Scarring A longitudinal or transverse incisions will result in a scar, which may form a keloid scar, particular in high risk ethnicities. Seroma A swelling of lymphatic fluid may occur particularly in the groin due to disruption of the lymph nodes and channels. Careful dissection of the lymphatic nodes and channels with ligation will minimise this risk. Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin to minimise this risk as deemed appropriate. Compartment syndrome Compartment syndrome may occur in patients with prolonged clamp times or in the acute setting. Patients with a long history of peripheral vascular disease are preconditioned for ischaemia so it is less likely. Minimise clamp times Stroke, MI, kidney failure, death Although small, this is always a risk in any major surgery Late Complication Description of Complication Potential Ways to Reduce Risk Hernia Any groin incision can cause a hernia if there is damage to the inguinal ligament or extensive lifting of the ligament during the procedure. Reintervention The common femoral artery may become stenosed again over time, requiring a redo procedure, or more proximal or distal disease may necessitate a bypass in the future. The graft can also fail over time. Frequent questions What is an axillofemoral bypass? An axillofemoral bypass is a surgical procedure performed to bypass significant aortic or bilateral iliac occlusions in patients unsuitable for aortic surgery. It involves the dissection and anastomosis of the axillary and common femoral arteries to restore blood flow. What are the common complications associated with axillofemoral bypass surgery? Common complications include haemorrhage, infection, and pain, as well as risks of blood clots and compartment syndrome. Proper surgical techniques and peri-operative care can help minimise these risks. How can the risk of infection be reduced during axillofemoral bypass? The risk of infection can be lowered by administering peri-operative antibiotics and ensuring careful dissection to avoid contamination. Superficial wound infections are most likely to occur in the groin area. What measures are taken to prevent blood clots during axillofemoral bypass surgery? To prevent blood clots, patients are often provided with anti-embolism stockings and low molecular weight heparin as deemed appropriate. These measures are particularly important for patients with risk factors like obesity or previous DVT. What are the potential late complications following an axillofemoral bypass? Late complications may include hernia formation at the incision site and the possibility of graft failure or re-stenosis of the common femoral artery. Regular follow-up is essential to monitor for these issues and determine if further intervention is needed. Rate This Article