Femoralfemoral Bypass

This is a maneuver by which full cardiopulmonary bypass can be established through the femoral artery and femoral vein (Fig. 3.3). Venous blood is taken from the femoral vein, transferred to the pump oxygenator and returned through the femoral artery to perfuse the patient's entire body. Blood from the femoral artery goes retrograde up the thoracic aorta to perfuse the aortic arch vessels and the coronary arteries. There are several instances in which femoral-femoral bypass may be required. One is a patient who had previous open heart surgery and is an extremely high risk for cardiac arrest during dissection of the previous adhesions. In such a situation, it may be advisable to prepare for femoral-femoral bypass since the aorta and right atrium may not be easily surgically accessible in the event of a cardiac arrest. Another situation where femoral-femoral bypass may be helpful is in descending thoracic or thoracoabdominal operations in which spinal cord protection may be afforded below the level of the cross-clamp by using femoral-femoral bypass. This technique may also be helpful for rewarming patients who present with hypothermic cardiac arrest, allowing rapid rewarming while maintaining cardiopulmonary support.

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