Periprocedural Care
Equipment
Equipment employed in performing a thoracofemoral (thoracic aortofemoral) bypass includes the following:
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Operating table
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Vascular tray
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Thoracotomy tray
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Double-lumen endotracheal tube and bronchial blocker/Univent
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Ability to perform on-table angiography
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Bean bag, pillows, and cushions to facilitate positioning
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Patient Preparation
Anesthesia
The thoracofemoral bypass requires general anesthesia, and most prefer left-lung isolation, though the procedure can be conducted with left-lung ventilation and appropriate retraction. Epidural anesthesia for postoperative pain control is also helpful. An arterial line and, often, a central line can be useful for the procedure as well.
Positioning
The patient is placed in a posterolateral thoracotomy position with the left chest at approximately 45º off the horizontal and with the pelvis in a horizontal position. The left arm is kept anteriorly and supported. [1]
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