What is Peripheral Vascular Disease?

Your arteries are normally smooth and unobstructed on the inside but they can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque builds up, your arteries can narrow and stiffen. Eventually, as the process progresses, your blood vessels can no longer supply the oxygen demands of your organs or muscles and symptoms may develop.

What is surgical bypass?

Surgical bypass treats your narrowed arteries by creating a bypass around a section of the artery that is blocked. During a bypass, your vascular surgeon creates a new pathway for blood flow using a graft. A graft is a portion of one of your veins or a man-made synthetic tube that your surgeon connects above and below a blockage to allow blood to pass around it.
You may be familiar with bypass surgery on heart arteries, but vascular surgeons also use bypasses to treat peripheral arterial disease (PAD). Surgeons use bypasses most commonly to treat leg artery disease, which is hardening of the arteries in the leg. Surgeons also use bypass to treat arm artery disease.

What can I Expect?

• Prior to your procedure, tests may be scheduled such as blood work, electrocardiogram (ECG), and chest x-ray. These may be done at a separate appointment, or the day of the procedure

• Your physician will order tests to locate the blockage and choose the best places to connect the graft.

These tests include:

• Duplex ultrasound: a non-invasive test that uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of your arteries
• CT Angiography: which produces x-ray pictures produced by an ultra-fast CT scanner, of the blood vessels in your legs using a contrast dye that is injected to highlight your arteries
• Magnetic resonance angiography (MRA): which uses magnetic fields and radio waves to show blockages inside your arteries
• Angiography: which produces x-ray pictures of the blood vessels in your legs using a contrast dye that is injected to highlight your arteries

• If you have arm or leg artery disease, your physician may order segmental blood pressures or pulse volume recording to determine the narrowing of the arteries in your arm or leg.

• If you have had a heart attack in the past, or if you have chest pain, your physician might recommend a stress test or, possibly, a heart catheterization.

• Your physician or vascular surgeon will give you the necessary instructions you need to follow before the surgery, such as fasting. Usually, your physician will ask you not to eat or drink anything 8 hours before your procedure.

• Your physician will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications.

What happens during surgical bypass?

Your specific surgical procedure depends on your symptoms, your overall physical condition, and how much plaque has built up in your arteries. Your surgeon, with the help of your anesthesiologist, may use either general or regional (epidural or spinal) anesthesia for the procedure.

• For an arm or leg bypass, your vascular surgeon usually first selects and removes the vein that will serve as the bypass graft for your artery. Your vascular surgeon usually uses your great saphenous vein (GSV) for the graft, if it is suitable. Your GSV runs under your skin between your foot and your groin. Sometimes your surgeon may need to use another vein or a synthetic fabric artery for the graft.

• To reach the bypass site in your blocked artery, your surgeon makes an incision in your skin over the artery.

• Once your surgeon exposes the artery, he or she evaluates the pulse in the healthy part of the artery. By checking the pulse, your surgeon makes sure that the artery provides enough blood flow to supply the bypass.

• Your surgeon next opens the artery below the part that is blocked. This is where he or she will connect one end of the graft.

• Your surgeon sews the graft into your artery with permanent stitches.

• Next your surgeon routes the other end of the graft between your muscles and tendons to a site above the blockage. In the same way, the surgeon then opens the artery and, at this location, stitches the graft onto this end of the artery.

•  Your surgeon checks the bypass for correct alignment and leakage. During the procedure, your vascular surgeon may perform an arteriogram or duplex ultrasound examination in the operating room to check the bypass for any problems.

•  When the surgery is complete, your surgeon closes all of the incisions.

• After the procedure, your surgeon may order a duplex ultrasound or other non-invasive tests, such as pulse volume recordings, to make sure the bypass is functioning properly.

What can I expect after surgical bypass?

• Your hospital stay may range from about 3 to 10 days.
• After you leave the hospital, your surgeon will remove staples or stitches from the incisions, usually about 4 weeks after your operation.

• You may need assistance from a visiting nurse, home health aide, or physical therapist when you first go home.

• If you develop fevers, a cold painful arm or leg, or if your incision area becomes extremely red, swells, or begins draining, you should contact your physician immediately.

• If you have PAD, your physician or surgeon may recommend that you take an antiplatelet medication, such as aspirin, which can help prevent blood clots.

Are there any complications?

Complications from bypass surgery are possible, but not usual. No procedure is risk-free, but you will experience a minimum number of complications if you select a well-trained vascular surgeon who specializes in the type of bypass surgery that your symptoms indicate.

Some complications from bypass surgery are less serious and may include swelling or inflammation at the incision site.

Others, such as blockage of the bypass, bleeding from the incision or infection, are potentially more serious. Your vascular surgeon will discuss the important risks and benefits with you and answer your questions.