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  • Disabling claudication.
  • Critical limb ischemia, defined as rest pain or tissue loss.


  • Debilitated patient with severe comorbidities.
  • Unaddressed inflow disease.
  • Lack of an appropriate distal target for revascularization.


  • Nondisabling claudication.
  • Nonambulatory patient.
  • Severe joint contractures.

  • The patient should be supine with both arms extended; procedure-specific positioning is indicated later.
  • A Foley catheter is inserted.
  • A radial arterial line is placed.

  • Doppler ultrasound signals should be checked frequently to monitor graft patency.
  • Patients are maintained on a β-blocker, an antiplatelet agent, and a statin unless contraindicated.
  • Antibiotics are stopped 24 hours after surgery unless there is an active infection (eg, an infected ulcer or toe).
  • Epidural injection or patient-controlled analgesia may be used for postoperative pain management.
  • Venous thromboembolic prophylaxis is started on postoperative day 1 using unfractionated heparin administered subcutaneously.
  • Patients with significant edema and pedal wounds are treated with an Ace wrap and leg elevation.
  • Sutures in the foot are removed only when the wounds are solidly healed, and not before 4 weeks.

  • Local wound infections.
  • Hematoma.
  • Lymph leaks.
  • Graft thrombosis.

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