Ask Dr. Z

For the following, would you report aneurysm repair or bypass?

"Indications: Presented with RLE rest pain and heel ulceration. Now for fem-pop bypass. A longitudinal right groin incision was made, the inguinal ligament mobilized, and the distal EIA and distal CFA were then encircled with vessel loops. The patient also had a pseudoaneurysm in the right CFA, which required excision and debridement. Through distal BK medial incision, the BK popliteal artery was exposed. It was obliterated midway down its course without any distinguishable lumen, and I dissected distally and obtained circumferential control of the TPT artery. We could not obtain adequate vein to perform a vein bypass. Right GSV was harvested, reversed, and end-to-end anastomosis was made between the graft and vein for a vein cuff. A subsartorial tunnel was created, proximal distal control of the TPT was achieved, a longitudinal arteriotomy was made. The distal free end of the vein was anastomosed in an end-side fashion to the TPT. In right groin, proximal and distal right CFA longitudinal arteriotomy was made, and the graft was tailored to an appropriate length for spatulated end-to-side anastomosis."