Vascular Disease Bypass

Overview

Vascular problems, particularly arterial blockages, can lead to inadequate blood circulation, resulting in wound and pain in the limbs. Bypass surgeries involve the redirection of blood flow around a blocked artery segment using a graft.

This graft can be made from either synthetic material or a vein sourced from your own body. In cases where your own veins are unable to utilize, synthetic materials are sometimes employed as substitutes. This procedure is performed to restore blood supply to the afflicted limb tissue, with the ultimate goal of preventing amputation.

Types of vascular bypass procedures

Different kinds exist. The name is based on both the bypassed artery and the arteries that receive the redirected blood flow. Among the most popular bypass techniques are the following:

• Aortobifemoral bypass: Starting in your abdomen, right above your pelvis, the graft is placed in the lower portion of your aorta. After that, it splits off like an upside-down Y to join the upper femoral artery in each leg.
• Femoral-popliteal bypass: The graft joins your popliteal artery above or below your knee after beginning in your groin or upper leg’s femoral artery.
• Femoral-tibial bypass: Starting in your groin or upper leg’s femoral artery, the graft travels down your leg to join the tibial arteries below the knee.

Reasons for undergoing the procedure

Vascular bypass surgery is typically recommended for individuals who have significant artery blockages in their lower limbs, which can also involve the abdominal aorta. Peripheral Artery Disease (PAD) causes critical limb ischemia, which is another term for severe arterial blockages.

Risks

Problems may arise during the surgery, in the aftermath, or even years afterward. Individuals who already have another medical condition, such as diabetes, kidney failure, or heart disease, are more susceptible to these problems. Risks include:

• Bleeding
• Infection
• Heart attack
• Pneumonia
• Injury to the nerves of the limbs, numbness or weakness
• Failure of the bypass graft, which is the restricted or obstructed blood flow through the graft.

Before the procedure

There are several tests available to assess your vascular health, pinpoint the arteries in need of treatment, and plan for your bypass surgery. Two potential tests are vascular ultrasonography and the ankle-brachial index.

Prior to commencing your vascular bypass surgery, your physician may conduct supplementary tests to rule out any cardiac vascular issues. It’s common for individuals with vascular disease in their limbs to also have concurrent cardiac vascular problems.

During the procedure

Your procedure will take place in a hospital. This is what to anticipate:

• General anesthetic will be administered by an anesthesiologist to ensure your comfort throughout the treatment.
• In order to access your veins and arteries, your surgeon will need to create incisions. The location and size of the incisions depend on the kind of bypass and graft.
• Your surgeon seals the wounds after manually sewing the bypass in place with small stitches.

The duration of the treatment varies according on the type of bypass used, typically taking two to six hours.

The saphenous vein, which is located in your leg just below the skin’s surface, is frequently used by medical professionals. Other possibilities are veins in the arms, like the cephalic vein. Your thigh’s femoral vein may be used if your doctor requires a larger vein.

Your surgeon will use a synthetic material for the bypass graft if they are unable to use your veins for it. For larger arteries, synthetic grafts function well; but, for minor vessel bypasses, your own vein works best.

After the procedure

You should anticipate spending a few days in the hospital. In order to avoid blood clots during the graft, you might also be taking anticoagulants, which thin the blood.

After surgery, both in the hospital and at home, your doctor will anticipate that you will get out of bed and move around. To do so, you might require additional assistance. Following the operation, some patients require physical and/or occupational rehabilitation. You’ll be able to resume your regular activities bit by bit.

Outcome

Successful bypass graft procedures often result in high limb salvage rates. However, it’s important to note that these procedures do not provide a cure for peripheral artery disease (PAD). Over time, grafts can experience narrowing or blockage.

The risk of graft failure significantly increases for individuals who use tobacco, including cigarette smoking. Therefore, it is crucial to maintain regular follow-up appointments with your vascular surgeon to monitor the status of your bypass and overall vascular health.