Peripheral Artery Bypass Surgery

 

What is peripheral artery bypass surgery?

Peripheral artery bypass surgery is used to treat severe peripheral artery disease (PAD). In PAD, blood flow through the arteries to your legs and feet is reduced because the arteries have become narrowed or blocked by fatty material called plaque. This condition is called atherosclerosis. The surgery involves using either a healthy blood vessel or manmade (synthetic) condult to create a detour (bypass) around the narrowed or blocked segments of the artery. This improves blood flow.

Quick facts

  • Peripheral artery bypass surgery restores blood flow to your legs and feet.

  • The surgery relieves pain, improves your activity level and reduces the chance that you will need amputation.

  • If you smoke, quit. Smoking increases the chance that you will need further surgery or possibly an amputation.

  • Regular physical activity may help you avoid future surgery.

  • If you have PAD, you are also at risk for heart attack and stroke.

 

Why do people have peripheral artery bypass surgery?

In PAD, fatty material called plaque builds up in the inner lining of the arteries that supply blood to your legs and feet. This buildup narrows or blocks your arteries and reduces the amount of blood and oxygen that gets to your leg muscles. As a result, you may have severe pain or weakness in your legs, and develop foot sores that won't heal. This puts you at risk for infection, tissue death (gangrene), and amputation of a foot or leg.

Doctors often use medicines and a procedure called peripheral angioplasty to open up the narrowed arteries, relieve your pain and save your legs and feet. If these treatments don't work well enough, your doctor may suggest peripheral artery bypass surgery. Surgery can help ease your pain and get you back to the activities you enjoy. It may also help you avoid amputation of a foot or leg.

What types of peripheral artery bypass surgery do doctors use?

Doctors identify these surgeries based on where an artery is blocked:

  • Tibioperoneal bypass is for arteries in your lower leg or foot.

  • Femoropopliteal, or fem-pop bypass, is for arteries above and below your knee.

  • Aortobifemoral bypass is for the abdominal aorta, the major artery that passes through your belly, and the large arteries that branch off of it.

 

What are the risks of peripheral artery bypass surgery?

All surgeries carry some risk. The risks of peripheral artery bypass surgery include:

  • Heart attack or stroke.

  • Bleeding.

  • Infection.

  • Swelling of your legs. Some mild swelling may be permanent.

  • Narrowing or blockage of the new blood vessel. If this happens, your symptoms may be worse than before surgery. You may need another bypass procedure or, in rare cases, an amputation.

 

How do I prepare for peripheral artery bypass surgery?

In general, doctors ask you to have a chest X-ray, an electrocardiogram (ECG or EKG) blood tests and urine tests. Your doctor may also ask you to have:

  • An angiogram before the surgery, so doctors can pinpoint where your arteries are narrowed or blocked.

  • An arterial blood flow test, which measures the flow of blood through your arteries and tells your doctor about the nature and location of any narrowed or blocked spots.

  • Duplex scanning, an ultrasound test that makes a picture of an artery or of the vein your doctor may use for the bypass surgery.

In addition:

  • Your doctor may ask you not to take medicines, such as aspirin, that affect blood clotting. You should discuss your medicine schedule with your doctor.

  • Don't eat or drink anything after midnight on the day of surgery.

  • On the morning of your surgery, you'll be admitted to the hospital. Your nurse will give you pre-operation medicines and prepare you for surgery.

 

What happens during peripheral artery bypass surgery?

A vascular surgeon performs this operation in a hospital. During the procedure:

  • A nurse puts an intravenous line (IV) in your arm. You get a medicine (general anesthesia) to put you to sleep.

  • The doctor uses either a vein taken from your leg or a man-made (synthetic) blood vessel to route blood around the blocked section of your artery.

  • The doctor sews one end of the vein to the artery above the blocked spot and attaches the other end to the artery below the blocked spot.

  • The surgery takes about 3 to 4 hours.

During this procedure a vein is grafted to reroute blood flow around a narrowed or blocked area in a peripheral artery restoring normal blood flow.
During this procedure a vein is grafted to reroute blood flow around a narrowed or blocked area in a peripheral artery restoring normal blood flow.

 

What happens after peripheral artery bypass surgery?

  • Nurses check on you frequently. If you have pain, ask the nurse for medicine.

  • Expect to have a catheter in your bladder for 1 or 2 days after the surgery. Also expect to get some fluids through an IV until you can drink on your own.

  • As you gain strength, your doctor will tell you when you can get out of bed and how much you should move. It's important to begin taking short walks, and to put some weight on the leg that had the surgery.

  • Your leg may swell after surgery. Your doctor may order elastic bandages for it to reduce the swelling.

 

What happens after I get home?

Before you leave the hospital, you'll get instructions on how to care for yourself while you recover. Here are some of the main points:

  • Recovery time differs for each person. Return to your normal activities gradually, and allow time for rest.

  • Get daily activity, such as walking, to increase blood flow, strengthen your muscles and help you feel better.

  • You will need to bathe or shower based on your doctor's recommendations. Make sure to completely and gently dry the incision (cut).

  • If you feel good, you can have sex after you have been home for 2 or 3 weeks. You can drive when you no longer have pain and can move your legs well. Ask your doctor when you can return to work. This will depend on your job and your condition.

  • It's important to take care of the skin on your feet and legs. Wear clean socks or stockings and shoes that fit well. Don't wear tight socks or panty hose.

 

What changes should I watch for?

Call your doctor if you notice:

  • A change in your incision such as a change in color, smell, and type or amount of fluid coming from it

  • Your incision swells, turns red, or feels hot or tender

  • A fever over 100° F

  • Sharp pain in your belly or legs

  • You can't move or feel your legs, or your legs tingle, feel cold or change color

 

What can I do to take care of myself in the future?

People with PAD usually develop atherosclerosis in other parts of the body. You can take steps to make all your blood vessels healthier.

  • If you smoke, quit. You may need more surgery or an amputation if you keep smoking. Avoid secondhand smoke.

  • Be physically active. Walk, ride a bike, or do other types of physical activity for at least 30 minutes five days a week.

  • Know your blood pressure numbers. Work with your doctor to reach a goal blood pressure of less than 120/80 mm Hg.

  • Lower your blood cholesterol levels by eating healthy foods (high in fiber and low in cholesterol, saturated fat and trans fat) and taking your cholesterol-lowering medicine. Keep your LDL "bad" cholesterol below 100 mg/dL. People who are at very high risk for coronary heart disease may benefit from lowering LDL cholesterol below 70 mg/dL.

  • If you have diabetes, work with your doctor to keep your blood sugar under control and maintain an HbA1c of less than 7 percent. HbA1c (hemoglobin A1c) is a blood test that measures your average blood sugar level for the previous 2 to 3 months.

These are also important:

  • If you are overweight, set your initial goal at a loss of 5 to 10 pounds. If you need to lose more, a weight loss of 1 to 2 pounds per week is recommended until you reach a healthy weight.

  • If you drink alcohol, have only 1 alcoholic drink a day if you're a woman, 2 if you're a man.

 

How can I learn more about peripheral artery bypass surgery?

Talk with your doctor. Here are some good questions to ask:

  • Where are my arteries blocked?

  • How do I keep the new sections of the artery from becoming blocked?

  • Will this surgery lessen my pain?

  • When will I be able to walk and engage in other types of physical activity?

  • How long will the new sections of artery last?

 

How can I learn about related topics?

Related topics include:

 

Publication Source: American Heart Association
Date Last Reviewed: 6/12/2008
Date Last Modified: 6/12/2008