Lower Extremity Bypass Operative Note (Infrainguinal)

Patient: [Name], MRN: [MRN], DOB: [DOB]

Date of Surgery: [Date]

Start/Stop Time: [Start time] – [Stop time]

Location: [Facility], [OR/Room]

Primary Surgeon: [Name]

Assistant(s): [Name(s) / None]

Anesthesia Type: [general / regional (neuraxial) / regional (peripheral nerve block) / MAC / local]

Urgency: [elective / urgent / emergent]

Laterality: [RIGHT / LEFT]

Preoperative Diagnosis

[Diagnosis with indication-level detail] (Include clinical syndrome such as CLTI with tissue loss, claudication, threatened bypass graft, or popliteal aneurysm with thromboembolization.)

Postoperative Diagnosis

[Same / Updated diagnosis based on intraoperative findings]

Procedure(s) Performed

• [Primary bypass: inflow artery to outflow artery, conduit type and configuration]
• [Adjunct procedure(s)] (List each separately: endarterectomy, patch angioplasty, thrombectomy, completion angiogram, fasciotomy, etc. Omit if none.)

Indications

[Brief explanation (3–6 sentences) of why bypass was chosen] (Include: clinical indication and acuity; key decision drivers such as anatomy, failed or unsuitable endovascular therapy, and vein availability; referenced preoperative imaging with key findings justifying target selection; baseline limb status including preoperative pedal signals/pulses, wounds, and neurologic deficits.)

Findings

• Inflow artery: [Quality, plaque burden, calcification, disease-free segment]
• Outflow/target artery: [Vessel caliber, calcification, runoff quality]
• Conduit: [Diameter range, quality, notable findings] (Omit if unremarkable.)
• Unexpected findings: [Findings requiring plan change] (Omit if none.)

Operative Data

EBL: [mL]; Fluids: [Crystalloid/colloid; blood products if given]; Urine Output: [mL / Foley not placed]; Drains: [Type and location / None]; Specimens: [Description and destination / None]; Complications: [None / Description with management]; Disposition: [PACU / ICU], [condition]

Implants/Grafts

[Prosthetic: manufacturer, type, size, lot/UDI] or [Autogenous conduit only: source vein] (Always complete this field.)

Description of Procedure

Setup: [Positioning]; [Prophylactic antibiotic and timing]; surgical time-out performed; [Prep and drape extent].

Exposure and Control: [Incision locations with laterality]; [Inflow artery exposed and controlled]; [Outflow artery exposed via (medial/posterior) approach and controlled]; [Calcification if present].

Conduit:

• Type: [ipsilateral GSV / contralateral GSV / small saphenous / arm vein / spliced vein / prosthetic]
• Harvest: [open / endoscopic / skip incisions], [site with laterality]
• Quality: [Diameter range], [varicosities], [sclerosis], [repairs if needed]
• Configuration: [reversed / nonreversed translocated / in situ with valvulotomy method]
• Preparation: [Distension, orientation marking, branch ligation, valve lysis as applicable]

(If prosthetic used, document why autogenous vein not used: unavailable, inadequate quality, infection, or prior harvest.)

Target Selection: [Inflow site and rationale]; [Outflow site and rationale]. (If target changed intraoperatively, document original plan, reason for change, and new target.)

Anticoagulation: [Heparin dose and route]; [ACT if checked]; [Clamp sequence]; [Protamine: dose / not given].

Tunneling: [Plane: subfascial/anatomic vs subcutaneous]; [Route: through adductor canal, relation to knee]; [Technique: tunneler vs manual]; no twist or kink confirmed.

Proximal Anastomosis:

• Type: [end-to-side / end-to-end]
• Arteriotomy: [Location with laterality], [length]
• Technique: [running / interrupted], [suture material and size]
• Adjuncts: [patch / hood / none]
• Flush/backbleed: [Sequence performed]

Distal Anastomosis:

• Type: [end-to-side / end-to-end]
• Arteriotomy: [Location with laterality], [length]
• Technique: [running / interrupted], [suture material and size]
• Distal control: [soft clamp / vessel loop / intraluminal occlusion]
• Target condition: [Calcification, plaque description]
• Adjuncts: [limited endarterectomy / tacking sutures / vein cuff / patch / none]
• Flush/backbleed: [Sequence performed]

Completion Assessment: [Modality: palpation / Doppler / duplex / angiogram / transit-time flow]. Findings: [Technical defect identified: yes/no]; [Revision performed: describe defect and correction / none required]; [Final assessment]. (Document actual observed findings; do not infer patency.)

Final Limb Perfusion: [Distal pulses: DP/PT palpable or Doppler character]; [Foot warmth and capillary refill]; [Compartment concerns if any]. (Reference preoperative baseline. If not assessed, state "not assessed" with reason.)

Hemostasis and Closure: Hemostasis achieved [with topical agents if used]. [Closure technique and materials]. [Dressings applied]. Counts correct per nursing.

Postoperative Plan

• Antithrombotic: [Antiplatelet/anticoagulation regimen; timing if held]
• Blood pressure: [Goals; note if graft flow is pressure-dependent]
• Neurovascular checks: [Frequency]; monitor [signals, pain, motor/sensory, graft exam]
• Wound care: [Dressing management, activity restrictions]
• Antibiotics: [Standard perioperative / extended duration with indication]
• Graft surveillance: [First duplex timing and follow-up plan]
• Escalation triggers: [Loss of signals, worsening pain, compartment syndrome, bleeding]