If collateral circulation has developed, patients with a stenosis or occlusion of the aortoiliac segment may be asymptomatic, or they may complain of buttock or low back discomfort associated with walking. Men may experience impotence. These patients may have decreased or absent femoral pulses.
The treatment of aortoiliac disease is essentially the same as that for atherosclerotic peripheral arterial occlusive disease. The sur-gical procedure of choice is the aortobi iliac graft. If possible, the distal anastomosis is made to the iliac artery, and the entire sur-gical procedure can be performed within the abdomen. If the iliac vessels are diseased, the distal anastomosis is made to the femoral arteries (aortobifemoral graft). Bifurcated woven or knitted Dacron grafts are preferred for this surgical procedure.
Preoperative assessment, in addition to the standard parameters, includes evaluating the brachial, radial, ulnar, femoral, posterior tibial, and dorsalis pedis pulses to establish a baseline for follow-up after arterial lines are placed and postoper-atively. Patient teaching includes an overview of the procedure to be performed, the preparation for surgery, and the anticipated postoperative plan of care. Sights, sounds, and sensations that the patient may experience are discussed.
Postoperative care includes monitoring for signs of thrombo-sis in arteries distal to the surgical site. The nurse assesses color and temperature of the extremity, capillary refill time, sensory and motor function, and pulses by palpation and Doppler every hour for the first 8 hours and then every 2 hours for the first24 hours. Any dusky or bluish discoloration, coolness, capillary refill time greater than 3 seconds, decrease in sensory or motor function, or decrease in pulse quality are reported immediately to the physician.
Postoperative care also includes monitoring for urine output greater than or equal to 30 mL/hour. Renal function may be im-paired as a result of hypoperfusion from hypotension, involvement of the renal arteries during the surgical procedure, hypovolemia, or embolization of the renal artery or renal parenchyma. Vital signs, pain, and intake and output are monitored with the pulse and extremity assessments. Results of laboratory tests are moni-tored and reported to the physician. Abdominal assessment for bowel sounds and paralytic ileus is performed at least every 8 hours. Bowel sounds may not return before the third postoperative day. The absence of bowel sounds, absence of flatus, and abdominal distention are indications of paralytic ileus. Manual manipulation of the bowel during surgery may have caused bruising, resulting in decreased peristalsis. Nasogastric suction may be necessary to decompress the bowel until peristalsis returns. A liquid bowel movement before the third postoperative day may indicate bowel ischemia, which may occur when the mesenteric blood supply (celiac, superior mesenteric, or inferior mesenteric arteries) is oc-cluded. Ischemic bowel usually causes increased pain and an el-evated white blood cell count (20,000 to 30,000 cells/mm3).
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