Lower extremity bypass with tumescent local anesthesia

Lower extremity bypass is most commonly performed for the treatment of critical limb ischemia. These patients often pose high surgical risk secondary to significant clinical comorbidities. These risks may be compounded when general anesthesia is considered. We present the case of a patient at high anesthesia risk with critical limb ischemia who was unable to receive general anesthesia or neuraxial blockade. An infrainguinal bypass was performed using tumescent anesthesia with minimal intravenous sedation. The patient was discharged 6 days later, and his postoperative course was complicated by a groin lymphocele. Tumescent local anesthesia is a possible alternative pain management strategy for patients undergoing lower extremity bypass surgery.