Peripheral Vascular Bypass
What is peripheral vascular bypass?
Surgical bypass treats your narrowed arteries by creating a detour, or bypass, around a section of the artery that is blocked. Your arteries can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque may build up in the walls of your arteries. Plaque is made up of cholesterol, calcium and fibrous tissue. Your arteries can narrow and stiffen as plaque builds up. Eventually, your blood vessels can no longer supply the oxygen demands of your organs and muscles, and symptoms may develop.
A bypass procedure involves creating a new pathway for blood flow using a graft. A graft can be a portion of one of your veins or a man-made synthetic tube. Your surgeon connects this above and below a blockage to allow blood to pass through it and around the blockage.
Preparation for the procedure:
A history and physical exam are performed. Your physician will want to know when your symptoms occur and how often.
Next tests are ordered which will help locate the blockage and choose the best places to connect the graft. These tests include duplex ultrasound, magnetic resonance angiography (MRA), computerized tomographic angiography (CTA), and/or angiography.
If you have arm or leg artery disease, you physician may order segmental blood pressures or pulse volume recording to determine the narrowing of the arteries in the involved area. If you have had a heart attack in the past, or if you have chest pain, you may need a stress test or, possibly, a heart catheterization.
Your vascular surgeon will give you the necessary instructions you need to follow before the surgery, such as fasting. Usually, you will be asked not to eat or drink anything after midnight the day before your procedure. Your physician will discuss with you the need to reduce or stop any medications that might increase your risk of bleeding.
During the procedure:
You may have either general or regional (epidural or spinal) anesthesia for the procedure.
Your vascular surgeon usually first selects and removes the vein that will serve as the bypass graft for your artery. Sometimes your surgeon may need to use a synthetic fabric artery for the graft.
Your surgeon makes an incision in your skin over the artery. Once he/she exposes the artery, the pulse in the healthy portion of the artery is evaluated. By checking the pulse, your surgeon can make sure that the artery provides enough blood flow to supply the bypass.
Your surgeon opens the artery below the part that is blocked. This is where he/she will connect one end of the graft. Your surgeon sews the graft into your artery. Next he/she will route the other end of the graft to a site above the blockage. The surgeon then opens the artery and, at this location, stitches the graft onto this end of the artery. The bypass is checked for correct placement and leakage. During the procedure, your vascular surgeon may perform an arteriogram or duplex ultrasound examination to check the bypass for any problems. Your surgeon closes all of the incisions and the surgery is complete.
After the procedure:
You will remain in the hospital for about 3 to 10 days. The staples or stitches in about 7 to 14 days, usually after you leave the hospital. You may need assistance when you first go home.
You should contact your physician immediately, if you develop fevers, a cold painful arm or leg, or if the incisional area becomes extremely red, swells, or begins draining. These may be signs of infection or other problems.
Your surgeon may also recommend that you take an antiplatelet medication, such as aspirin, which can help prevent blood clots.
How to stay healthy:
Surgical bypass does not stop plaque from building up again. You should make changes in your lifestyle to preserve the success of your bypass graft. These changes will help lower your blood pressure and decrease the chances that plaque will affect your graft or other arteries. These changes include:
- A diet low in fat, cholesterol, and calories
- Blood cholesterol levels within normal limits
- An ideal body weight
- Aerobic exercise such as brisk walking, for 20-30 minutes at least 5 times each week
- No smoking