Aortobifemoral bypass

Overview

Aortobifemoral bypass surgery is a type of vascular disease bypass surgery conducted within the abdominal region by skilled surgeons. A new route (bypass) is made for blood to flow around obstructed or narrowed sections of the arteries during this open operation and as a result, the legs will obtain better blood flow.

An artificial blood vessel (graft) is inserted into the abdomen by a vascular surgeon at the location of the diseased arteries. Polyester is frequently used for the graft. The term “Aortobifemoral” refers to the arteries joining the graft; “Aorto” stands for the aorta, “Bi” indicates that the graft joins both femoral arteries, and “Femoral” refers to the femoral arteries.

The graft is shaped like an upside-down “Y.” The lower section of the abdominal aorta is joined to the top of the graft there. The femoral arteries are linked to each of the Y’s stems.

If the patient experiences significant symptoms or is at a high risk for problems due to plaque formation in the patient’s major abdominal or pelvic arteries, a surgeon may advise this procedure.

Reasons for undergoing the procedure

Severe aortoiliac occlusive disease is treated with aortobifemoral bypass surgery. Major arteries in the pelvis and abdomen gradually fill with plaque as a result of this illness.

The abdominal aorta and iliac arteries can become narrowed or blocked by significant plaque formation. As a result, there is not enough oxygen-rich blood available to the lower body’s organs, which include the legs, foot, and pelvic region. Complications from severe narrowing or blockages include:

• Intermittent claudication (pain at the legs when walking)
• Severe leg pain when resting
• Gangrene
• Amputation

Aortoiliac occlusive disease cannot be permanently cured, but symptoms can be alleviated through bypass surgery, which helps improve blood flow to the legs. This procedure can reduce the chances of experiencing the mentioned issues.

Risk

The following are possible complications of aortobifemoral bypass surgery:

• Heart attack
• Stroke
• Blood clots
• Bleeding
• Surgical wound infection
• Graft infection
• Kidney failure
• Lung failure

Prior to surgery, it’s important to go through all potential risks with the surgical care team.

Procedure

Open surgery called an aortobifemoral bypass requires an important large abdominal incision. Healthcare providers should take into account this important procedure.

Aortoiliac stenting with bifurcation reconstruction (AISBR) is a minimally invasive procedure. A stent is inserted in the blocked arteries during this type of endovascular surgery to help increase blood flow. According to certain studies, AISBR may result in a shorter hospital stay and a lower risk of surgical complications than open surgery.

The choice between open surgery and endovascular surgery is typically determined by the healthcare provider based on the patient’s individual circumstances. In the past, surgeons often opted for AISBR in cases where patients had a higher surgical risk. However, due to advancements in technology, today’s surgeons are increasingly favoring AISBR over open surgery.

If a patient is not a candidate for endovascular surgery or had endovascular surgery in the past but it wasn’t successful, they may require open surgery. Discuss the patient’s alternatives with the healthcare provider, including the advantages and disadvantages to the patient’s unique circumstances.

Before the procedure

The patient will be instructed by the surgical care team on how to get ready for operation. The following instruction includes:

• Stop smoking: For at least three to four weeks before to their surgery, they should refrain from using any tobacco products. After surgery, the patient should keep quitting smoking in order to protect the health of their heart and blood vessels and reduce their risk of cardiovascular disease.
• Medications: In order to prepare for surgery, the patient might need to change their medicine routine. They can be asked to take specific medications prior by the healthcare provider.
• Fasting: The patient will receive instructions from the healthcare provider on how to fast, or refrain from eating and drinking the night before surgery.
• Testing: Patient may need different tests prior to the procedure such as ankle-brachial index (ABI), vascular ultrasound, and imaging test of the heart and coronary arteries.

During the procedure

The surgical team will carry out the following procedures in order to reroute blood flow in the abdomen:

• In order to put the patient into a deep sleep, they will be given general anesthesia.
• Perform a laparotomy by making one lengthy incision (cut) in the abdomen. The surgeon can access their aorta.
• To reach the femoral arteries, surgeon will make an incision at the top of each thigh.
• Applying the graft. The apex of the graft will be attached to the aorta, above the blocked or narrowed area, by the surgeon. The bottom two pieces of the graft will be sewn to the femoral arteries below the blocked or narrowed section.
• Use staples or stitches to close the incisions in the upper thighs and abdomen.

After the procedure

The patient will recover in the hospital for four to seven days. Throughout this period, the medical team will:

• Will closely monitor for any signs of complications.
• Examine the leg blood flow.
• Encourage the patient to gradually move more each day.
• Pain medication may be provided if needed.

Outcome

Aortoiliac occlusive disease symptoms may be lessened and the risk of complications reduced with aortobifemoral bypass surgery. Following their recovery, they receive the following advantages from this surgery:

• While at rest, the patient won’t experience any more leg pain.
• The patient will be able to walk farther than before because of decreased leg pain brought on by reduced blood flow.
• To avoid gangrene, the patient should be able to heal wounds on his or her legs and feet.

For at least five years, 80% to 95% of procedures successfully enhance blood flow. Between 74% and 86% of operations succeed after ten years.

It can take two to three months for full healing. But within four to six weeks, they ought to be ready to resume some of their regular activities.

Incision pain may persist in the patient for a few weeks following surgery. If pain medicine is required to make the patient feel better, the healthcare provider will prescribe it. Make sure to:

• Follow the directions of their healthcare provider’s prescription for all medications, including the painkiller. Find out if they have any questions concerning the details of their medication routine.
• Take care of the incisions as directed by the healthcare provider.
• Exercise, such brief walks that get a little bit longer each time, can boost the healing process.

If the patient experiences any of these problems while recovering, call the healthcare provider immediately:

• Fever.
• Nausea and vomiting.
• Any incisions that are painful or warm to the touch.
• Skin that is discolored (appearing red, brown, purple, or white) surrounding any incisions.
• Leg or groin redness or swelling.
• Drainage from the incisions.
• Ulceration of the skin that get worse.
• Anywhere on the leg or foot that has cold, pale, or blue skin.