Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Significant chronic lower extremity ischemia. Lifestyle-limiting claudication, tissue loss, and rest pain.Risk factor modification partially helpful.Acute lower extremity ischemia. Thrombosed aortoiliac system.Infected aortic graft (prior abdominal aortic graft for aneurysmal or occlusive disease).Abdominal aortic aneurysm with iliac disease (occlusive or aneurysmal). +++ Absolute ++ Chronic ischemia: none.Acute ischemia: nonsurvivable acidosis. +++ Relative ++ Cardiopulmonary comorbidities.Prior abdominal surgery.If significant comorbidities exist, extra-anatomic bypass (axillary-femoral bypass) is preferred. ++ The patient should be supine and prepared from mid chest to the feet. The abdomen is entered through a midline incision.Groin incisions can be transverse but more often are longitudinal. ++ Arterial line, central line, and pulmonary artery catheter for hemodynamic monitoring.Nothing by mouth.A nasogastric tube is needed for decompression for 12–24 hours in cases of abdominal entry. ++ Respiratory failure.Renal failure.Myocardial infarction. Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth