Lower extremity bypass with tumescent local anesthesia

Lower extremity bypass is most commonly performed for the treatment of critical limb ischemia. These patients often pose high surgical risk secondary to significant clinical comorbidities. These risks may be compounded when general anesthesia is considered. We present the case of a patient at high anesthesia risk with critical limb ischemia who was unable to receive general anesthesia or neuraxial blockade. An infrainguinal bypass was performed using tumescent anesthesia with minimal intravenous sedation. The patient was discharged 6 days later, and his postoperative course was complicated by a groin lymphocele. Tumescent local anesthesia is a possible alternative pain management strategy for patients undergoing lower extremity bypass surgery

Successful off-label use of the GORE EXCLUDER Iliac Branch Endoprosthesis to preserve gluteal perfusion during staged endovascular repair of bilateral isolated hypogastric aneurysms

Endovascular repair of iliac artery aneurysms has emerged as an alternative to traditional open surgical repair. Although there is little consensus on indications to preserve hypogastric blood flow during aneurysm repair, it is well understood that complications from bilateral hypogastric occlusion may be significant. The GORE EXCLUDER Iliac Branch Endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz) received United States Food and Drug Administration approval in March 2016 for treatment of common iliac artery and aortoiliac aneurysms. This case report discusses an off-label use of GORE EXCLUDER Iliac Branch Endoprosthesis to maintain pelvic perfusion during treatment of bilateral internal iliac artery aneurysms without surrounding aortoiliac pathology