The pneumatic tourniquet: a useful adjunct in lower extremity distal bypass.

Pneumatic tourniquet techniques can facilitate numerous vascular surgical procedures by providing a bloodless surgical field and minimizing vessel wall trauma. Vessel dissection is simplified by requiring only a short segment of anterior vessel wall exposure, and trauma is avoided to the perianastomotic arterial branches and accompanying veins. Tourniquet use is particularly helpful for the distal anastomosis of infrapopliteal and pedal bypass procedures, but is also ideal for localized endarterectomy procedures. Correction of vein graft stenosis in upper extremity dialysis access procedures greatly facilitates removal of infected prosthetic grafts in the distal upper or lower extremity. The potential complications of nerve compression, ischemic skeletal muscle damage, and reperfusion problems associated with tourniquet use are not a clinical problem with the short occlusion times required for vascular procedures. The absence of clamps improves the anastomotic visualization and increases the mobility of the surgical site to aid surgical anastomotic techniques. The clinical use of pneumatic techniques among vascular surgeons continues to increase as surgeons become aware of its utility and expand its applications.