Axillobifemoral Bypass under Local Anesthesia in a Patient with Critical Limb Ischemia: A Way to Protect the Limb to Improve Lifestyle and Reduce Morbidity and Mortality

Critical limb ischemia (CLI) is a severe obstruction of the arteries, which markedly reduces the blood flow to extremities and has progressed to the point of severe pain, skin ulcers, and gangrene. The pain caused by it can wake up an individual, which is why it is also called “rest pain.” We did axillobifemoral bypass in this patient for relief of symptoms. Patients with multiple comorbidities are usually in danger of any untoward incident causing a risk of life on the table and develop morbidity following general anesthesia, due to which local anesthesia is preferred in such patients while performing these procedures, following which strict postoperative monitoring is required. This is illustrated by a case of a 52-year-old male having CLI Fontaine grade III and Rutherford category IV, who was a chronic smoker with multiple comorbidities, and having an American Society of Anesthesiologist grade 5, making him a high-risk candidate for general anesthesia. Thus, the path of local anesthesia was chosen.