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PATIENT INFO - PERIPHERAL ARTERY BYPASS
Peripheral artery bypass is surgery to reroute the blood supply around a blocked artery in one of your legs. Your peripheral arteries can become blocked with fatty material that builds up inside them. This is called atherosclerosis.
Peripheral artery bypass surgery is similar to coronary artery bypass surgery (CABG), a treatment for disease in the arteries that supply blood to the heart. During the surgery, a healthy vein from another part of your body (usually the saphenous vein that runs from your thigh to your ankle) is used to re-route blood around the diseased artery.
Types of peripheral vascular bypass
The types of peripheral vascular bypass procedures include:
- Aortic bypass - is the bypass of a blocked section of your aorta. Your aorta is the main artery leaving your heart. It passes down through your abdomen (belly).
- Axillary artery bypass - is the bypass of the artery in your underarm.
- Femoral artery bypass - is the bypass of the artery in your thigh.
- Iliac artery bypass - is the bypass of the artery in your pelvis.
- Popliteal artery bypass- is the bypass of the artery in your knee.
- Tibial artery bypass - is the bypass of the artery in your lower leg.
In addition to a peripheral vascular bypass, your doctor may also perform one or more additional procedures. These include:
- Angiography - which is a procedure that allows your doctor to take a picture or image (called an arteriogram) of your artery.
- Doppler ultrasound - which produces images of the flow of blood through your artery.
Reason to Undertake Surgery
In PAD, fatty material called plaque builds up in the inner lining of the arteries that supply blood to your legs and feet. This buildup narrows or blocks your arteries and reduces the amount of blood and oxygen that gets to your leg muscles. As a result, you may have severe pain or weakness in your legs, and develop foot sores that won't heal. This puts you at risk for infection, tissue death (gangrene), and amputation of a foot or leg.
Doctors often use medicines and a procedure called peripheral angioplasty to open up the narrowed arteries, relieve your pain and save your legs and feet. If these treatments don't work well enough, your doctor may suggest peripheral artery bypass surgery. Surgery can help ease your pain and get you back to the activities you enjoy. It may also help you avoid amputation of a foot or leg.
Risks
- Bleeding or blood clots
- Graft blockage
- Heart attack or stroke
- Breathing problems
- Infection
- Need for second bypass or surgery to remove dead tissue (amputation)
- Nerve damage and numbness
- Complications from anesthesia
Before the Procedure
The steps you take before surgery can improve your outcome after the procedure. You can prepare yourself for a peripheral vascular bypass by:
- Answering all questions about your medical history and medications you take. This includes prescribed medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Getting pre-operative testing as directed. Testing varies depending on your age, health, and specific procedure. Pre-operative testing may include a chest X-ray, electrocardiography (ECG), blood tests, and other tests as needed.
- If you are overweight, talk to your doctor about losing weight before the surgery through a healthy diet and exercise plan.
- If you have diabetes, talk to your doctor about how to control your blood sugar both before and after surgery. Good blood sugar control can help decrease your risk of complications with a peripheral vascular bypass.
- Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure due to a risk of complications. These include choking on stomach contents during deep anesthesia.
- Stop smoking as soon as possible. Even quitting for a just few days can be helpful.
- Taking or stopping medications exactly as directed. For a peripheral vascular bypass, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
During surgical bypass
Your specific surgical procedure depends on your symptoms, your overall physical condition, and how much plaque has built up in your arteries. Your surgeon, with the help of your anesthesiologist, may use either general or regional (epidural or spinal) anesthesia for the procedure
- For an arm or leg bypass, your vascular surgeon usually first selects and removes the vein that will serve as the bypass graft for your artery. Your vascular surgeon usually uses your great saphenous vein (GSV) for the graft, if it is suitable. Your GSV runs under your skin between your foot and your groin. Sometimes your surgeon may need to use another vein or a synthetic fabric artery for the graft.
- To reach the bypass site in your blocked artery, your surgeon makes an incision in your skin over the artery.
- Once your surgeon exposes the artery, he or she evaluates the pulse in the healthy part of the artery. By checking the pulse, your surgeon makes sure that the artery provides enough blood flow to supply the bypass.
- Your surgeon next opens the artery below the part that is blocked. This is where he or she will connect one end of the graft.
- Your surgeon sews the graft into your artery with permanent stitches.
- Next your surgeon routes the other end of the graft between your muscles and tendons to a site above the blockage. In the same way, the surgeon then opens the artery and, at this location, stitches the graft onto this end of the artery.
- Your surgeon checks the bypass for correct alignment and leakage. During the procedure, your vascular surgeon may perform an arteriogram or duplex ultrasound examination in the operating room to check the bypass for any problems.
- When the surgery is complete, your surgeon closes all of the incisions.
- After the procedure, your surgeon may order a duplex ultrasound or other non-invasive tests, such as pulse volume recordings, to make sure the bypass is functioning properly.
After the Procedure
After surgery, you will stay briefly in the recovery room until your vital signs are stable.Depending on the specific procedure, you may then stay in a regular hospital room or an intensive care unit (ICU). ICUs provide 24-hour monitoring and care.
- After aortoiliac or aortofemoral bypass, you may need to spend 1 or 2 days in bed. You will probably be in the hospital for 4 to 7 days.
- After femoral popliteal bypass, you will spend less time or no time in the ICU.
Recovery after surgery is a gradual process. How long it will take for you to recover and return to normal activities varies depending on the specific procedure and type of anesthesia used, your general health, age, and other factors. Your doctor will likely refer you to an exercise rehabilitation program to help you recover. Full recovery times range from four to six weeks.
At home:
- Shower and wash your incision daily with an antibacterial soap.
- Routinely check your incision for any signs of infection such as redness or draining.
- Keep your feet elevated as much as possible.
- No driving for 2-3 weeks after surgery.
Complications
Complications from bypass surgery are possible, but not usual. No procedure is risk-free, but you will experience a minimum number of complications if you select a well-trained vascular surgeon who specializes in the type of bypass surgery that your symptoms indicate. Some complications from bypass surgery are less serious and may include swelling or inflammation at the incision site.Others, such as blockage of the bypass, bleeding from the incision or infection, are potentially more serious.