If extensive areas of artery are blocked and causing symptoms, an arterial bypass may be required. This involves using a conduit (a flexible tube) to allow blood to flow around the blockage and thus bypass the blockage. The conduit of first choice is usually a vein taken from the leg or sometimes an arm. The body has few arteries but many veins and taking a vein to use as an artery does not cause any impediment. Occasionally vein is not available and the next option is a prosthetic graft.
In the work-up for the bypass it is usually to have an angiogram to make the diagnosis but also to plan the surgery carefully. It is also usually to have an ultrasound of the veins of the arm and leg to plan which conduit can be used. A medical workup and routine blood tests will be performed.
The operation can be performed under general anaesthetic or spinal anaesthetic and there are several factors in deciding this and your anaesthetist will discuss this with you.
After the anaesthetic, incisions are made over the arteries above and below the blockage. This incision can also usually be used to harvest the necessary vein, but occasionally separate incisions are required to harvest the necessary vein. The arteries are carefully dissected out and prepared for surgery. A blood thinner called heparin is administered and then clamps are applied to the artery above the blockage and the artery opened longitudinally over approximately a centimetre to allow the conduit to be sutured to it. This is then checked. The conduit is then passed through a carefully fashioned tunnel to the lower artery area and the process repeated. The vessels are thoroughly flushed before the anastomoses are completed. All areas are checked to bleeding before closing the leg in layers. Drains may be used.
Post-operatively the leg and wounds will be carefully observed in the ward. Routine post anaesthetic care including antibiotics and pain relief will be administered. Usually, you will be sitting out of bed in a day or so, and walking in 2 to 3 days. The usual hospital stay is between 5 and 10 days.
Most bypass operations go well but there are some potential complications including anaesthetic related complications, bleeding, infection, low blood count requiring transfusion and graft failure. Occasionally, an unplanned repeat operation may be required. In the worst case scenario, the viability of the leg may be threatened, though this is very uncommon.
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