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  1. 9. QUESTION

    Lower Extremity Bypass Grafts

    Writing Requirement

    Write pathophysiology and duplex assessment of lower extremity bypass grafts, APA style, with three good references.
    The first part of this paper must include the types of lower extremity bypass grafts that are currently being done and the pathophysiology of the arterial disease.
    Include information concerning which patients are routinely referred for evaluation of lower extremity disease. Include at least three reasons for referrals for scanning a patient with a bypass graft.
    Please also include information concerning which patient population most commonly has severe lower extremity disease (i.e. diabetics).
    To aid in this process, select at least three vascular references. (Hint: What is the disease process and how do we access patency?)
    The second focus of this paper is to explore duplex testing protocols and procedures related to lower extremity bypass grafts.
    How is the duplex exam performed and interpreted?
    A definition of patient symptoms and an understanding of the difference between acute and chronic situations.
    Explain how the diagnosis is made and discuss diagnosis accuracy.

    Reading Requirements
    Zweibel, 6th Edition Introduction of Vascular Ultrasound Sonography

    Read Chapters 17-19 – if you dont have the book, just write, but make sure you include it as one of the citations, and even intext

    Zweibel, 5th edition, 18,19 and 20.
    You can also include other articles from the JVT index, or OIT’s Library medical databases or weblinks.
    You must have at least 3 good references whenever possible.


Subject Nursing Pages 4 Style APA


Lower Extremity Bypass Grafts

A Lower extremity bypass graft is a surgical procedure that is commonly used to redirect the flow of blood in the legs or limbs, particularly, for individuals with peripheral artery disease (PAD). PAD is a lower extremity disease that often obstructs the normal flow of blood in the lower limbs as a result of narrowed arteries (Ouriel, 2012). In this case, a doctor attaches a special tube (graft) to the blocked artery to reroute blood around the blockage. The graft can either be natural or manmade(Ouriel, 2012). The two most common types of bypass grafts that are normally used for lower extremity disease include femoral popliteal bypass and distal bypass. A femoral popliteal bypass is usually done on the upper part of the leg on the popliteal artery end behind the knee  (Layden et al., 2012). On the other hand, a distal bypass is done on the lower part of the leg below the knee (Layden et al., 2012). A patient with a bypass graft may be referred for scanning if the incision begins to drain; if their pain increases without ceasing, and when their leg swells without any signs of improvement.This paper analyzes the pathophysiology and duplex assessment of lower extremity bypass grafts.

   The prevalence of the lower extremity disease (PAD) has become a significant problem globally. Research has shown that about 12 million people in the U.S suffer from PAD (Layden et al., 2012). As a result, individuals with a family history of atherosclerosis or PAD are routinely referred for evaluation of lower extremity disease (Ouriel, 2012). Similarly, studies have pointed out that obesity and diabetic patients tend to have severe cases of lower extremity disease because the ailments tend to enhance the narrowing of the arteries which promotes PAD due to the accumulation of plaque in the blood vessels (Layden et al., 2012). In this case, patients are advised to manage their risk factors and adopt a healthy lifestyle to prevent or control the sickness.

Pathophysiology of the Arterial Disease

The Peripheral arterial disease is mainly caused by atherosclerosis which causes the narrowing the arteries due to the accumulation of plaque. The disease may manifest acutely when emboli, thrombi, or acute trauma compromises perfusion (Layden et al., 2012). Thrombosis tends to occur in the lower extremities due to multiple factors such as hypotension, aortic dissection, and underlying atherosclerotic narrowing of the arterial lumen(Ouriel, 2012). Whether the arterial disease is caused by thrombus or embolus, occlusion results in both distal thrombus proximal formation as a result of blood flow stagnation.

Part 2

Duplex Testing protocols and Procedures

The duplex testing protocols related to lower extremities bypass require physicians to assess and monitor the patient’ physical and mental status to ensure that they are ready for the procedure and able to provide an informed consent. The care providers are also required to analyze the sonographic findings to make sure that the available data is sufficient to direct the patient management and render a final diagnosis (Zwiebel, 2005).  The duplex exam combines both traditional and Doppler ultrasound. The physician uses a transducer or a small microphone to examine the arteries. Some of the symptoms that are commonly associated with PAD include pain when walking, critical limb ischemia, and pain in the soles of the feet, just to mention (Gornik & Sharma, 2014). A sample of blood can also be used to measure the client’s  cholesterol levels and check for diabetes.




Beard, J. D., Gaines, P. A., & Loftus, I. (Eds.). (2013). Vascular and Endovascular Surgery E-Book: Companion to Specialist Surgical Practice. Elsevier Health Sciences.

Gornik, H. L., & Sharma, A. M. (2014). Duplex ultrasound in the diagnosis of lower-extremity deep venous thrombosis. Circulation, 129(8), 917-921.

Ouriel, K. (2012). Peripheral arterial disease. The Lancet, 358(9289), 1257-1264.

Zwiebel, W. J. (2005). Ultrasound assessment of the Aorta, iliac arteries, and inferior vena cava. Introduction to vascular ultrasonography. Fifth edition. Elsevier, 29, 529-532.



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