Tourniquets in Arterial Bypass Surgery

Eyers, P; Ashley, Stanley W.; Scott, D. J. A.

doi:10.1053/ejvs.2000.1140

Cited by 8 publications

(4 citation statements)

References 48 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additional studies have investigated the use of a tourniquet as a substitute for vascular clamps in distal arterial bypasses, with lower long-term complication rates possibly due to a lack of vascular intimal damage. 19,20 Even with these results, the use of a tourniquet may not always be appropriate, such as for patients who have had prior revascularization procedures. 21 Microsurgery techniques that utilize an extremity have likewise been employed following traumatic injuries and for oncologic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Extremity-Based Microsurgery

Corbett

Rocks²,

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

Background The use of tourniquets and their role in extremity-based microsurgery has not been thoroughly investigated. The purpose of this study was to investigate tourniquet use and its associated outcomes and complications. Methods Approval from the Institutional Review Boards was granted at each site. A retrospective chart review was completed for patients who had undergone extremity-based microsurgery with the use of a tourniquet between 01/01/2018 and 02/01/2021 at two large academic institutions. Demographic characteristics, initial reasons for surgery, complications, and outcomes were recorded. Patients were separated into groups based on tourniquet-use during three operative segments: (1) flap elevation, (2) vessel harvest and (3) microvascular anastomosis. An internal comparison of complication rate was performed between cases for which a tourniquet was used for one operative segment to all cases in which it was not used for the same operative segment. Univariate and multivariate statistical analyses were performed to identify statistically significant results. Results A total of 99 patients (106 surgeries) were included in this study across sites. The mean age was 41.2 years and 67.7% of the patients were male. The most common reason for microsurgical reconstruction was a traumatic event (50.5%). The need for an additional unplanned surgery was the most common surgical complication (16%). 70% of procedures used a tourniquet for flap elevation. When these cases were compared to those that did not use a tourniquet for flap elevation, there was no difference in complication rates. 61% of procedures used a tourniquet for vessel harvest and 32% for anastomosis. Similarly, additional analyses identified no difference in complication rates when compared to procedures for which a tourniquet was not used for the intervention. Conclusions Based on these results, the authors encourage the use of tourniquets for extremity-based microsurgery to enable bloodless dissection without the concern of increased complication rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Extremity-Based Microsurgery

Corbett

Rocks²,

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…In addition, there have been a few studies that have examined the use of the tourniquet in lower extremity procedures in patients with previous revascularizations. Eyers et al 8,38 conducted a study on the use of the Esmarch tourniquet in femoro-distal bypass procedures. Of 168 consecutive cases (164 patients), 78 percent were primary, 20 percent were secondary, and 2 percent were tertiary vascularization procedures.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Still, 2 hr is the most common tourniquet time recommended based on histologic, metabolic, functional, and clinical studies. 8,[12][13][14] Even when practicing within commonly used tourniquet guidelines, there have been many case reports of serious complications. It is important to note that tourniquet use causes both compressive and ischemic injury to muscle, nerve, and vascular tissues.…”

mentioning

confidence: 99%

Use of the Tourniquet in Reconstructive Surgery in Patients with Previous Ipsilateral Lower Extremity Revascularization: Is it Safe? A Survey

Dučić

Chang

Dellon³

2006

J reconstr Microsurg

View full text Add to dashboard Cite

Tourniquet use in the previously revascularized ipsilateral lower extremity varies among micro-reconstructive surgeons due to the possible complication of graft failure. Examination of evidence-based literature and a current standard of care is needed to establish guidelines for such tourniquet use. Surveys were sent to vascular surgery program directors of ACGME-accredited residency programs to assess prevailing tourniquet use instruction. The survey addressed issues, including tourniquet use in previous bypass surgery, previous angioplasty, and location relative to graft anatomy. Twenty-eight responses were received out of 87 surveys sent (32 percent response rate). Ninety-three percent considered tourniquet use inappropriate in the ipsilateral lower extremity with previous revascularization. Seventy-one percent indicated tourniquet use inappropriate in previous ipsilateral angioplasty. Sixty-one percent regarded graft conduit type to be important in tourniquet use. There remains a lack of prospective, randomized, controlled studies determining risks of occlusion and other complications to the preexisting bypass graft during tourniquet use. Until such studies are done, this survey recommends avoiding tourniquet use in this patient population.

show abstract

“…However, tourniquets continue to be successfully and safely used in peripheral bypass surgery in many centers, as they require less dissection of the artery than is needed to place a clamp. 46…”

Section: Managing the Fragile Anastomosis: Clampless Surgerymentioning

confidence: 99%

Distal Bypasses in Patients With Diabetes and Infrapopliteal Disease

Forsythe

Jones

Hinchliffe

2014

The International Journal of Lower Extremity Wounds

View full text Add to dashboard Cite

The combination of diabetes and peripheral arterial disease (PAD) is challenging in many ways. The characteristic and complex distal distribution of PAD often encountered in patients with diabetes means that bypass surgery in this context is technically challenging. In addition, many of these patients have a burden of serious comorbidities that must be optimized and managed concurrently. While the authors acknowledge that "achieving success" in distal bypass relies on much more than technical expertise, there are some technical aspects that should be considered when planning surgery on these patients. This article outlines some important issues in the treatment pathway of a patient with diabetes and PAD requiring distal bypass surgery--from selection and optimization of the patient (in the context of a multidisciplinary team) and preoperative workup, to the operative strategy planning, technical tips, and nonoperative adjuncts. These considerations, as well as sound knowledge of the underlying disease process, confounding medical factors and awareness of the difficulty in predicting treatment outcomes, should help maximize the chances of success.

show abstract

Tourniquets in Arterial Bypass Surgery

Abstract: the use of a tourniquet is a safe and effective technique to facilitate arterial reconstruction.

Cited by 8 publications

References 48 publications

Tourniquet Use in Extremity-Based Microsurgery

Tourniquet Use in Extremity-Based Microsurgery

Use of the Tourniquet in Reconstructive Surgery in Patients with Previous Ipsilateral Lower Extremity Revascularization: Is it Safe? A Survey

Distal Bypasses in Patients With Diabetes and Infrapopliteal Disease

Contact Info

Product

Resources

About