General Surgery: The Fem-Fem Bypass

This morning I went to JPS at 6:30 a.m. to help BR see some patients before going to lecture. I saw three patients in Telemetry East before BR caught up to me. I asked him which patients hadn't been seen yet, and he said, "All of them." Apparently while I'd been looking up patient data and talking to them, he'd been chatting with other doctors at the nurses' station! *sigh* Lecture was wasted on me; I couldn't stop yawning in class (at one point I dozed off). It made no sense for me to be so tired since I wasn't even on call last night (Amar was, and he stayed awake pretty well). I treated myself to a long lunch break and a green tea latte before driving back to JPS (only Dustin and I went back; Amar was post-call and Phuong got the afternoon off). I found BB in the OR and he let me scrub in with him for surgery. The assigned procedure was an axillary-femoral bypass/femoral-femoral bypass, which involved inserting a graft that ran from the axillary artery to the femoral artery (yes, it would run along the entire length of the body), and then inserting another graft that connected the two femoral arteries by running above the pubic bone. This sounded intimidating, but word was passed down from Dr. A (the other vascular surgeon) that he hoped to only do the fem-fem bypass. That would decrease the total surgery time by an hour or two, which sounded good to everyone.

The patient, an overweight woman, had her entire body painted with an iodine substitute, but even after we were all scrubbed in and ready to go, we had to wait nearly 45 minutes for Dr. A to arrive b/c he was doing an angiogram. This was BB's first time doing such a procedure (he's a 2nd year resident) so he wasn't even allowed to make the first cut. That honor went to Dr. A. The first thing to do was find the femoral pulse, which was hard because the woman had both occluded arteries and excess body fat, not a good combination. At one point Dr. A asked the anesthesiologist how much the woman weighed, and he replied, "100 kg." To this, Dr. A said, "She does not weigh just 100 kg." Dr. A and BB had to make incisions at least 2 inches deep in order to reach the arteries, and Dr. A had to keep using a Doppler to find the pulse. In this manner, it took up to 1 hr alone to find the arteries (which were "small" compared to her body weight).

Once the arteries were found, Dr. A made a slit up the left femoral artery and removed a white plaque that was lining the artery. Even still, he said the occlusion was not too bad; it was less than 90% so blood still flowed through. Then he sewed a Gortex graft (looks like a long white tube) to the left femoral artery, made a tunnel above the pubic bone with his fingrs, looped the graft to the opposite side, made a slit in the other artery, and sewed the other end of the graft there. Then the incisions were sewn and stapled (I only got to do the stapling; this reminded me of my OB days). The surgery took about 3 hrs to complete, and that was just for the fem-fem bypass alone. And after seeing how heavy the patient was, Dr. A said that he probably would have had lots of trouble doing an axillo-femoral bypass since there was so much tissue to work with, and we were all grateful that all the patient needed was a fem-fem to restore her pedal pulses. BB let me put my fingers on the graft to feel the blood pulsing through it; pretty cool. I was fairly sore and hungry by the end of the surgery, but BB had been NPO all day (and the surgery ended at 6 pm) so I didn't complain.

Tomorrow I'm on call =/ We'll see how it goes.