arterial bypass

Lower Extremity Arterial Bypass for Peripheral Arterial Disease (PAD)

What is lower extremity arterial bypass? 

Arterial bypass treats your narrowed arteries by creating a new pathway around a section of the artery that is blocked.  Your arteries are normally smooth and unobstructed on the inside but they can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque builds up, your arteries can narrow and stiffen. Eventually, as the process progresses, your blood vessels can no longer supply the oxygen demands of your organs or muscles and symptoms may develop.

You may be familiar with bypass surgery on heart arteries, but vascular surgeons also use bypasses to treat peripheral arterial disease (PAD). Surgeons use bypasses most commonly to treat leg artery disease, which is hardening of the arteries in the leg.

If you have symptoms of atherosclerosis, you may be a candidate for bypass surgery. Symptoms can range from pain in the legs during activity, called intermittent claudication, to the development of non-healing ulcers or gangrene (tissue death) in more severe cases. You may be a candidate for bypass surgery even if you are not eligible for angioplasty, stenting, or atherectomy. 

Surgery overview

Your specific surgical procedure depends on your symptoms, overall physical condition, and how much plaque has built up in your arteries.  You may have either general anesthesia or regional (epidural or spinal) anesthesia for the procedure. 

For a bypass, your vascular surgeon usually first selects and removes a vein that will serve as the bypass material for your blocked artery.  A common vein that is used is the “greater saphenous vein” (GSV) which runs under your skin between your foot and your groin.  If this vein is unsuitable, another vein, or synthetic material may be used to create the bypass.

To reach the bypass site in your blocked artery, your surgeon makes an incision in your skin over the artery.  Once the artery is exposed, the pulse is evaluated in the healthy part of the artery.  By checking the pulse, your surgeon makes sure that the artery is able to provide enough blood flow to supply the surgical 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 bypass. Next your surgeon routes the other end of the bypass 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 bypass 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 to make sure the bypass is functioning properly.

What can I expect after surgical bypass? 

Your hospital stay may range from about 3 to 10 days. After you leave the hospital, your surgeon will remove staples or stitches from the incisions, usually about 7 to 14 days after your operation. You may need assistance from a visiting nurse, home health aide, or physical therapist when you first go home.  Your surgeon may recommend that you take aspirin or another medication to prevent blood clots.

If you develop fevers, a cold painful leg, or if your incision area becomes extremely red, swells, or begins draining, you should contact your physician immediately.

Risks

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 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. Your vascular surgeon will discuss the important risks and benefits with you and answer your questions.

Factors that increase your chances of complications include:

  • High blood pressure
  • Obesity
  • High cholesterol
  • Coronary artery disease
  • Chronic obstructive pulmonary disease, such as emphysema
  • Poor kidney function
  • Diabetes
  • Smoking 

If you are unsure whether you have any of these risk factors, your primary care provider can perform tests to determine if you do.

What you can do to stay healthy 

Surgical bypass does not stop plaque build up. If you have bypass surgery, you should make changes in your lifestyle to preserve the success of your bypass. You should consider changes that will help lower your blood pressure and decrease the chances that plaque will affect your bypass or other arteries. These changes include:

  • Eating foods low in fat, cholesterol, and calories
  • Maintaining your ideal body weight
  • Exercising aerobically, such as brisk walking, for 20 to 30 minutes at least 5 times each week
  • Quitting smoking 

Copyright by the Society for Vascular Surgery and North Point Domain

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