Pneumatic Tourniquet Occlusion of Lower Extremity Revascularization and Upper Extremity Hemodialysis Access Procedures

Abstract

Despite centuries of use in orthopedic procedures, pneumatic tourniquets were not described for a large series of vascular patients until 1980. Even since that time, acceptance of the technique has remained slow to develop among vascular surgeons. Advantages of this technique are many, including prevention of clamp trauma to vessels, better visualization of the arteriotomy or venotomy, and less required dissection. Tourniquets have found application in lower extremity revascularizations for popliteal or distal anastomoses as well as upper extremity hemodialysis access procedures. Disadvantages are few, with minimal risk of complications at the inflation times required for vascular procedures. Neuromuscular injury can be further prevented by minimizing the tourniquet inflation pressures by direct determination of the arterial occlusion pressures. Clinical applications should continue to grow as more vascular surgeons become aware of the benefits of the tourniquet techniques.