Distal bypasses, by Rob Davies.

0800 - 0820

BTK Rob Davies

Clarence

Excellent talk

Lots of illustrations / operative images / a few videos

All about open reconstruction BTK

Distal and ultra distal bypasses

Showed a couple of cadaveric exposures such as to the distal Peroneal

Some very good technical tips; such as when exposing for PT3 to always start at the top end of wound because the fragile plantar skin will fall apart if that is the initial incision

Similarly useful comments about offsetting the incision towards the DPA to one side and undermining towards DPA - RD says the DPA is often deeper than one expects

Says he has moved towards placing a more lateral incision when approaching the CFA in order to sweep all the lymphatics medially away from the vessel and minimise lymphatic complications

Mentioned the BEST CLI trial result at the start - that open revascularisation is more favoured over endo in patients who have good GSV

Spoke about the value of having multiple (or at least 2) operators in order to whittle down the duration of a distal bypass from 4-5 hours instead to 2-3

Spoke of the need for a patient anaesthetist who is a vascular specialist

RD prefers to use valulotomised vein for his bypasses, especially for very distal targets due to the ability to match the cablibres better; however also stated that the valves are much stronger in arm vein, due to (he says) previous venotomy related fibrosis etc, and therefore he tends to reverse rather than valvulotomise the arm vein when he uses that as conduit.

Seems to favour a different valvulotome device over the Le Maitre one.