Axillobifemoral Bypass Graft: A Student Dissection Experience

Abstract

As first-year medical students, we were excited, but nervous, to start the anatomy course. We were prepared to dedicate ourselves to the physical demands of dissection, and the hours of memorizing names and relations of countless anatomic features. We expected to leave the anatomy course with a comprehensive understanding of the human body that we would apply to our future studies and careers. We were not prepared, however, for the experience we had with our cadaver, Lucy.* Lucy was a small woman, but as we learned, she had endured a lot, physically and medically, in her 83 years of life. She had a pacemaker. She had coronary artery disease and a triple bypass procedure. She also had severe peripheral artery disease and had undergone at least one extraordinary surgical graft procedure to maintain blood flow into her lower extremities. The surprise of discovering a small piece of an axillobifemoral bypass graft and then continuing to uncover it, region by region, throughout the anatomy course, brought our dissection experience and our connection to Lucy to a more profound level than we could ever have anticipated.*The name Lucy was chosen as a pseudonym to protect the identity of the cadaver. GETTING TO KNOW LUCYWe first met Lucy on a Wednesday evening the week prior to the start of the Clinical and Developmental Anatomy course. Our meeting was facilitated by a kind physician who volunteered to introduce us, and by our second-year peer assistant. Being in the anatomy lab for the first time, in the presence of so many deceased, was an overwhelming experience. Our physician carefully guided us through an inspection of Lucy's frail body. We identified several scars that hinted about procedures she had undergone, but otherwise Lucy seemed to be in pretty good shape.°C orresponding Author: priti.mishall@einstein.yu.edu. Author Contributions: JDM, KE, KA, and DA contributed equally to the preparation of this manuscript. RAH prepared the figures. PLM, SAD, and RAH provided editorial support and guidance. HHS Public AccessAuthor manuscript Einstein J Biol Med. Author manuscript; available in PMC 2017 January 25. DISSECTION REPORTA week later, as we removed the skin from Lucy's thorax, we found a pacemaker resting on her left pectoralis major muscle. However, there was significant atrophy of her right pectoralis major muscle, which did not make much sense to us since the pacemaker was on her left side. Then, we uncovered a large, red, tube-shaped "muscle" running down the lateral aspect of her right chest. Truthfully, we didn't know what we had uncovered, but compared with other cadavers in the lab, we knew it was unusual and we were intrigued. Faculty members visited our cadaver to help us identify our "muscle." They were also unsure of what it was. Other students had hypotheses of their own. One thought it might be Lucy's esophagus. Another thought it might be a ventricular-peritoneal shunt.By the time we left the thorax and moved on to Lucy's abdomen, we knew the "muscle" was a tube-a bypass graft-but we didn...