Lower Extremity Bypass

You may be familiar with heart bypass but vascular surgeons use similar procedures to treat blocked arteries elsewhere in the body. The surgeon uses a vein in your body that you donít need or a synthetic tube to create a new pathway or a detour around a blocked artery. The vein or synthetic graft is attached to the arteries above and below the blockage with sutures. The technique is commonly used for blocked arteries in the legs, but can also be used to treat blockages in the arms and other locations in the body.

How do I prepare for the operation?

Tests required before the operation include blood tests, chest X-ray, an ultrasound and CT scan angiogram. You will need to go to the Pre-Surgery Clinic at Trillium West Toronto and meet with an anesthetist before the operation. Ideally you should attempt to complete all these tests before the visit so the anesthetist can review the results with you. You also need to have a checkup with your family physician prior to surgery. You should take your surgical package to all the appointments. You may continue taking aspirin but other blood thinners such as Plavix or Coumadin need to be stopped before surgery.

What does the operation consist of?

The specific details depend on the type of bypass you are having. Your surgeon and anesthetist may recommend a general or a spinal anesthetic. Your surgeon will make incisions to expose the arteries above and below the blockage. Additional incisions may be required if a vein graft is to be used. Vein grafts are usually removed from the legs but occasionally arm veins can be used if no leg vein is available. Some types of bypasses can be done only with vein grafts and some with synthetic grafts. Your surgeon can choose the best option for your particular circumstances.

What happens after the operation?

You may need to stay in the hospital for 2 Ė 10 days depending on the type of bypass and your condition. You will be cared for on the surgical ward or rarely in the Intensive Care Unit depending on your type of bypass. You may have an epidural catheter for 1-3 days after surgery. The bladder catheter is removed 1-2 days after surgery. You will be encouraged to start walking soon after surgery.

Recovery at Home

At home you should try to resume walking and normal activities. Many patients experience leg swelling in the operated leg. This generally improved after a few weeks. You should elevate your leg during the day and avoid standing for prolonged periods. You may have discomfort around the incision in the first month or so. You may feel tired and not feel like eating for a month or more. Your energy level and appetite should return to normal by 3 months. You should shower daily and clean the incision with soap and water. Your staples will be removed 2 weeks after surgery by your surgeon or family physician. You may resume driving after 2 weeks and sexual relations after 4-6 weeks. Large pre-existing wounds may take many months, even up to a year, to heal, even after successful bypass.

Complications

Major complications after bypass surgery can occur in up to 5% of cases. Possible complications include death, bleeding, blockage in the bypass, infection, heart problems and even a small risk of limb loss. Early or late clotting of the graft can occur and can lead to recurrent symptoms. To prevent this, you will be given blood thinners and medication to lower your cholesterol. It is essential not to smoke and to walk every day after bypass surgery. Your surgeon will also arrange for regular ultrasound monitoring of your bypass especially during the first two years after surgery.