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Posted: April 30th, 2022
# Peripheral Artery Bypass: A Lifesaving Procedure for PAD Patients
Peripheral artery disease (PAD) is a condition that affects millions of people worldwide. It occurs when plaque, a fatty substance, builds up inside the arteries that supply blood to the legs, arms and other organs. This reduces the blood flow and oxygen delivery to the tissues, causing pain, numbness, weakness and poor wound healing. In severe cases, PAD can lead to gangrene, amputation or even death.
Fortunately, there is a surgical treatment that can restore blood flow and save limbs and lives: peripheral artery bypass. In this blog post, we will explain what peripheral artery bypass is, how it works, who needs it, what are the risks and benefits, and what to expect before, during and after the procedure.
## What is peripheral artery bypass?
Peripheral artery bypass is a surgery that creates a new route for blood to flow around a blocked or narrowed artery in the leg or arm. The surgeon uses a graft, which is either a synthetic tube or a vein taken from another part of the body (usually the opposite leg), to bypass the diseased segment of the artery. The graft is attached to the healthy parts of the artery above and below the blockage, allowing blood to flow through it and reach the affected limb or organ.
Peripheral artery bypass can be done on different arteries, depending on where the blockage is located. Some of the common types of peripheral artery bypass are:
– Aortobifemoral bypass: This surgery bypasses the aorta (the main artery that comes from the heart) and both iliac arteries (the arteries that branch off from the aorta and supply blood to the lower body). It is usually done for people who have severe PAD in both legs or who have abdominal aortic aneurysm (a bulge in the wall of the aorta).
– Femoropopliteal bypass: This surgery bypasses the femoral artery (the main artery in the thigh) and the popliteal artery (the artery behind the knee). It is usually done for people who have PAD in one leg that causes pain when walking or non-healing ulcers on the foot.
– Femorotibial bypass: This surgery bypasses the femoral artery and the tibial arteries (the arteries in the lower leg). It is usually done for people who have PAD in one leg that causes severe pain at rest or gangrene.
## How does peripheral artery bypass work?
Peripheral artery bypass works by improving blood flow and oxygen delivery to the affected limb or organ. This can relieve symptoms such as pain, numbness, weakness and poor wound healing. It can also prevent complications such as infection, tissue death and amputation.
Peripheral artery bypass can also improve quality of life and functional status for people with PAD. They may be able to walk longer distances, perform daily activities more easily and enjoy a better mood and self-esteem.
## Who needs peripheral artery bypass?
Not everyone with PAD needs peripheral artery bypass. The decision to have surgery depends on several factors, such as:
– The severity of symptoms
– The location and extent of blockage
– The response to other treatments, such as medications, lifestyle changes and minimally invasive procedures
– The overall health and risk factors
– The personal preferences and goals
Peripheral artery bypass is usually reserved for people who have severe PAD that causes:
– Pain in the leg at night or when resting
– Sores or wounds on the leg or foot that do not heal
– Dead tissue or gangrene on the leg or foot
– Threat of limb loss
Peripheral artery bypass may also be considered for people who have moderate PAD that causes:
– Pain in the leg when walking that limits daily activities
– Poor quality of life due to PAD symptoms
– Failure of other treatments to improve symptoms
## What are the risks and benefits of peripheral artery bypass?
Like any surgery, peripheral artery bypass has potential risks and benefits. The risks may vary depending on the type of surgery, the health condition of the patient and other factors. Some of the possible risks are:
– Bleeding
– Infection
– Graft failure or blockage
– Wound complications
– Nerve injury
– Blood clots
– Heart attack
– Stroke
– Death
The benefits of peripheral artery bypass may include:
– Improved blood flow and oxygen delivery to the affected limb or organ
– Reduced pain and discomfort
– Enhanced wound healing and tissue survival
– Prevention of limb loss and amputation
– Improved quality of life and functional status
The surgeon will discuss with the patient the specific risks and benefits of peripheral artery bypass before the surgery. The patient should weigh them carefully and ask any questions they may have.
## What to expect before, during and after peripheral artery bypass?
Before peripheral artery bypass, the patient will undergo several tests and evaluations to determine the suitability and plan of the surgery. These may include:
– Blood tests
– Electrocardiogram (ECG)
– Chest X-ray
– Ultrasound
– Angiogram
– Ankle-brachial index (ABI)
The patient will also receive instructions on how to prepare for the surgery, such as:
– Stopping smoking and drinking alcohol
– Taking or stopping certain medications
– Fasting for several hours before the surgery
– Arranging for someone to drive them home and help them after the surgery
During peripheral artery bypass, the patient will receive anesthesia to prevent pain and discomfort. The type of anesthesia may depend on the type of surgery and the preference of the patient and the surgeon. It may be:
– General anesthesia: The patient will be unconscious and unaware of the surgery.
– Epidural or spinal anesthesia: The patient will be numb from the waist down and awake but sedated.
– Local anesthesia: The patient will be numb in the area of the surgery and awake but relaxed.
The surgeon will make an incision over the blocked or narrowed artery and place clamps on both ends to stop blood flow. The surgeon will then attach the graft to the healthy parts of the artery above and below the blockage. The surgeon will check for good blood flow in the graft and the limb or organ. The surgeon will then close the incision with stitches or staples.
The duration of peripheral artery bypass may vary depending on the type of surgery and the complexity of the case. It may take from 2 to 6 hours.
After peripheral artery bypass, the patient will be taken to a recovery room or an intensive care unit (ICU) for close monitoring. The patient may have:
– A bandage or dressing over the incision site
– A tube in the bladder to drain urine
– A tube in the chest to drain fluid
– An intravenous (IV) line to deliver fluids and medications
– Electrodes on the chest to monitor heart rate and rhythm
– A pulse oximeter on the finger to measure oxygen level in the blood
– A blood pressure cuff on the arm to measure blood pressure
The patient may feel some pain, discomfort, swelling or bruising in the area of the surgery. The patient may also feel some numbness, tingling or weakness in the affected limb or organ. These are normal and expected after peripheral artery bypass. The patient will receive pain medications and other treatments to ease these symptoms.
The patient will stay in the hospital for several days after peripheral artery bypass. The length of stay may depend on the type of surgery, the recovery progress and any complications. During this time, the patient will:
– Receive antibiotics to prevent infection
– Receive blood thinners to prevent blood clots
– Receive physical therapy to improve mobility and circulation
– Receive wound care to promote healing
– Receive education and counseling on how to care for themselves at home and prevent recurrence of PAD
The patient will be discharged from the hospital when they are stable and ready to go home. The patient will need someone to drive them home and help them with daily activities for a few weeks. The patient will also need to follow up with their surgeon and other healthcare providers regularly after peripheral artery bypass. The follow-up visits may include:
– Checking the incision site for signs of infection or healing problems
– Removing stitches or staples
– Performing tests to evaluate blood flow in the graft and the limb or organ
– Adjusting medications as needed
– Providing advice on lifestyle changes, such as quitting smoking, eating a healthy diet, exercising regularly, managing stress, controlling blood pressure, cholesterol and blood sugar levels
Peripheral artery bypass is a major surgery that requires careful preparation, execution and recovery. It can improve blood flow, relieve symptoms, prevent complications and enhance quality of life for people with PAD. However, it is not a cure for PAD. It is important for patients who undergo peripheral artery bypass to follow their surgeon’s instructions, take their medications as prescribed, attend their follow-up visits and adopt healthy habits to maintain their graft function and prevent recurrence of PAD.
## References
: Cleveland Clinic. Peripheral Artery Bypass Surgery. https://my.clevelandclinic.org/health/treatments/24461-peripheral-artery-bypass (accessed January 9, 2024).
: MedlinePlus. Peripheral artery bypass – leg. https://medlineplus.gov/ency/article/007394.htm (accessed January 9, 2024).
: Healthgrades. Peripheral Vascular Bypass: Why It’s Done, Risks, What to Expect. https://www.healthgrades.com/right-care/vascular-conditions/peripheral-vascular-bypass (accessed January 9, 2024).
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