Peripheral artery bypass

Overview

Peripheral artery bypass surgery is a procedure designed to restore blood flow in cases of narrowed or blocked leg (or arm) arteries, commonly occurring due to peripheral artery disease (PAD). The constriction is often a result of plaque build-up composed of cholesterol and fats, impeding the smooth flow of blood. This arterial obstruction hinders the efficient delivery of oxygen and nutrients to the surrounding tissues. In response to this vascular challenge, healthcare providers intervene by creating an alternative pathway for the blood to circumvent the blockage. Analogous to constructing a new highway to divert traffic away from a congested area, this surgical intervention provides a clear route for blood flow, enabling it to bypass the impediment and nourish the tissues adequately.

This surgical procedure creates a bypass for the blood, enabling it to detour around the blocked artery. This redirection is comparable to diverting traffic from a congested road, ensuring a smoother and unobstructed pathway for the blood to reach its intended destination. The result is a consistent and unhindered delivery of vital nutrients and oxygen to the tissues in need.

Reasons for undergoing the procedure

Peripheral artery bypass surgery might be recommended for individuals with a severe blockage in a long, narrow section of an artery in their leg or arm. This option is typically considered when other treatments for peripheral artery disease (PAD) prove ineffective.

You may require this surgery if you experience:

• Nighttime or walking leg pain: Pain in your leg during the night or when walking.
• Non-healing leg sores: Sores on your leg that are not healing.
• Gangrene (dead tissue): Presence of dead tissue, known as gangrene.

If you are dealing with any of these symptoms, your healthcare provider may discuss peripheral artery bypass surgery as a potential solution.

Risks

Peripheral artery bypass surgery may entail complications such as blood clots, infection, bleeding, peripheral nerve damage, and a 3% risk of heart attack. While fatalities occur in 2% to 5% of cases, the majority of patients don’t experience major issues. Elevated risk is associated with age over 70 and existing health problems. Some may require additional surgery due to graft blockages, often addressed with minimally invasive procedures.

Before the procedure

Tests that your vascular surgeon might recommend the following:

• Electrocardiogram (EKG)
• Stress test
• Ultrasound
• Blood tests

It’s critical to give up tobacco use before to a peripheral artery bypass if you are aware that you will be getting one. This may reduce your risk of complications following surgery.
The day prior to the procedure, you might have to avoid intake of food, drinks, and some medications.

During the procedure

The vascular surgeon will administer anesthesia to ensure you are pain-free and asleep during the procedure. They will then create an incision, typically ranging from 4 to 8 inches, both above and below the artery affected by the blockage. Additional incisions may be made if a vein needs to be harvested for the bypass. The surgeon will implant a blood vessel graft from another part of your body, connecting it above and below the obstructed segment of the artery. Finally, the incisions will be closed using either staples or stitches. The duration of peripheral artery bypass surgery can vary, ranging from under two hours to as long as six hours.

After the procedure

Following surgery, your healthcare provider will attentively monitor vital signs like pulse, blood pressure, temperature, and breathing, as well as assess the circulation in your legs. They will provide pain medication as needed and may prescribe post-operative medications, including a statin, aspirin, and clopidogrel to support your recovery and overall health.

Outcome

Recovery from peripheral artery bypass surgery typically spans six to eight weeks. While returning to work is feasible within a few weeks, the resumption of a regular eating routine should be gradual.

Hospital discharge occurs between two to five days post-surgery. Following the procedure, patients may experience:

• Low appetite: Reduced interest in eating is common.
• Incision discomfort: Pain or numbness around incisions is to be expected.
• Leg swelling: Some degree of swelling in the leg is normal.
• Muscle pain: Pain during walking may occur.

Patients should promptly contact their healthcare provider if the following issues arise after discharge:

• Fever or chills: Indicators of a possible infection warrant attention.
• Incisional changes: Any unusual discharge from incisions should be reported.
• Changes in leg: Changes in the appearance or sensation of the leg should be communicated.

Regular follow-up appointments are essential for postoperative monitoring. Providers utilize ultrasound assessments to ensure optimal blood flow in the legs, emphasizing the importance of attending all scheduled appointments for comprehensive care and successful recovery.