Retrograde iliofemoral TEA (ring stripper disobliteration) on the right with profunda patch plasty

Skin incision and division of the subcutis approximately 1 cm lateral to the palpable femoral artery. Medial to the M. sartorius, the thigh fascia is incised, and the superficial femoral artery can then be exposed and looped. Below the inguinal ligament, the crossing lymphatic collectors are divided between clamps and secured with transfixion ligatures.

Tips:

1. Access approximately 1 cm lateral to the artery spares the lymphatic collectors and allows a later overlapping wound closure with the aim of improved wound healing.

2. The early exposed or looped superficial femoral artery serves as a guide during dissection towards the proximal side.

3. Transfixion ligatures of the lymphatic collectors help to largely avoid later lymphocysts or lymph fistulas. Lymphatic accumulations in the groin often pave the way, particularly in stage IV PAOD, for a deep wound infection that endangers the extremity and even the patient's life.

Preparation and looping of the common femoral artery. In this process, lymphatic and fatty tissue are dissected from lateral to medial. Exposure of smaller side branches and the deep femoral artery. Control of the medial and lateral circumflex femoral arteries.

Tips:

1. The deep femoral artery must be dissected at least up to the third branching for a profundaplasty, because otherwise – as has been experimentally confirmed – improved inflow cannot be achieved.

3. Transversely running, crossing veins should be managed with transfixing ligatures, as simple ligatures easily slip off.

4. Small arterial branches can be managed with thread tourniquets. The use of numerous bulldog clamps restricts the freedom of movement in the operative field, and during vessel suturing the threads often get caught in the clamps.