Bypass Vascular Surgery

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Bypass Vascular Surgery

A vascular bypass (or vascular graft) is a surgical procedure performed to redirect blood flow in a region of the body. It is commonly performed due to inadequate blood flow (ischemia) and as a part of organ transplantation.

In general, someone's own vein is the preferred graft material (or conduit) for a vascular bypass, but other materials such as ePTFE, dacron or a different person's vein (allograft) are also commonly used.

Arteries can also be redirected and serve as vascular grafts. A surgeon sews the graft to the target vessel by hand using surgical suture, creating a surgical anastomosis.

Risks and complications

A number of complications can arise after vascular bypass.

Risks related to bypass

Acute Graft Occlusion is the occlusion (blockage) of a vascular bypass graft shortly after the bypass is performed. Its causes, which are distinct from those of chronic graft occlusion, include technical failure (e.g. anastomotic stricture, incomplete valve lysis in non-reversed vein) and thrombosis. It is rare, but almost always requires reoperation.

Risks related to surgery

• Hemorrhage (Bleeding).
• Infection.
• Embolism.

Common bypass sites include the heart (Coronary artery bypass surgery), and the lower extremities, where vascular bypass is used to treat peripheral vascular disease.

Description

You will be given a general or spinal anesthetic so that you will feel no pain during the operation. If needed, you will be given a blood transfusion.

• A fem-pop bypass, the most common type, uses a natural or synthetic graft to create the detour around the blockage beginning at your groin/thigh crease and ending at the inner knee, or sometimes the calf or foot.
• An incision, about 4–8 inches long, is made at the groin crease and again at the end point.
• If your own vein is used to create the graft, other small incisions may be made on the inner portion of the thigh. Otherwise, a synthetic tube made of fabric (Dacron) or plastic (PTFE, Gortex) will be used.
• After the initial two week recovery phase, most angioplasty patients can begin to safely return to low-level exercise. A graduated exercise program is recommended whereby patients initially perform several short bouts of exercise each day, progressively increasing to one or two longer bouts of exercise. As a precaution, all structured exercise should be cleared by a cardiologist before commencing.
• The graft is sewn to the artery at both ends with fine stitches.
• Surgery can take 1.5–6 hours.

For an aortic bypass, a synthetic graft made of fabric (Dacron) or plastic (PTFE, Gortex) is used, and a vertical midline abdominal incision is made. Surgery can take 3–4 hours.

Recovery

Immediately following vascular bypass surgery, patients recover first in the intensive care unit or Coronary care unit for one to two days. Provided that patients recover normally and without complications, then are then allowed to move to a less intensively monitored unit such as a step-down unit or a ward bed. Monitoring immediately after all types of bypass surgery focuses on signs and symptoms of bleeding. If bleeding is detected, treatment can range from transfusion to reoperation. Later on in the hospital course, common complications include wound infections, pneumonia, urinary tract infection and acute graft occlusion.

At discharge, patients are prescribed oral painkillers, and should be prescribed a statin and an anti-platelet medication if their bypass was performed for atherosclerosis (PVD or CAD as tolerated. Some patients start feeling normal after one month, while others may still experience problems up to six months after the procedure.

During the first twelve weeks after the procedure patients are advised to avoid heavy lifting, hose work as well as strenuous recreation like golf, tennis, or swimming while surgical wounds (particularly the sternum after coronary bypass) heal.

Part of the recovery after any bypass surgery includes regular visits to a physician to monitor the patient's recovery. Normally a follow up visit with a surgeon is scheduled for two to four weeks after surgery. The frequency of these visits gradually lessens as the patient's health improves.

For vascular bypass operations performed for atherosclerosis (PVD and CAS), the operation does not cure the underlying disease. Instead, lifestyle changes that include quitting smoking, making diet changes, getting regular exercise, and lowering stress improve the underlying condition.

Risks

The bypass graft can become blocked soon after surgery or years later. This is sometimes remedied by another surgery or catheter procedure, sometimes by a new bypass.

Other possible complications soon after surgery include:

• Heart attack, as many patients with PAD also have heart disease.
• Wound infections, though antibiotics are given before and after surgery to help prevent this.
• Bladder or other infections.
• Pneumonia

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