ABSTRACT
Preop Assessment of iliac artery inflow is mandatory before performing a femorofemoral
bypass. Assessment should consist of a pulse examination combined with an arterial noninvasive study with Doppler waveform analysis. If the pulse is normal and the Doppler waveform reveals a normal triphasic signal, adequate inflow can be assumed. If the Doppler waveform is not normal, further assessment with imaging modalities is necessary. These imaging modalities can consist of a magnetic resonance angiogram
I (MRA), computed tomography angiogram (CTA), or conventional digital subtrac tion contrast angiogram. The imaging modality will be best determined based on the quality of the image that can be provided by the equipment at the individual hospital, and taking into account that contrast angiography is an invasive procedure. However, a benefit of performing contrast angiography is that if inflow disease is detected, it can be treated percutaneously with balloon angioplasty and stenting in the same setting. Assessment of outflow is also necessary before performing a femorofemoral bypass in order to determine where the recipient anastomosis will be placed and to determine if additional outflow procedures, such as an endarterectomy, are necessary. Again, this assessment can be performed with any of the imaging modalities described above. Ankle-brachial indexes (ABI) are performed preoperatively as a baseline for comparison after the procedure. The patient should receive aspirin preoperatively to minimize the risk of thrombosis of the prosthetic material.
