What You Need to Know About Aortofemoral Bypass Surgery
Bypass Surgery
The use of aortofemoral bypass surgery to manage aortoiliac occlusive diseases dates back to the mid-twentieth century. With the advancement of medical science, new methods such as minimally invasive surgery with endovascular procedures have been introduced.
However, sometimes your surgeon will tell you that endovascular intervention is not an appropriate option for you. If that’s the case, you would need bypass surgery. This article will get all the necessary information about aortofemoral bypass surgery.
What is Aortoiliac Occlusive Disease?
Obese people with high cholesterol, particularly smokers, are more likely to develop fatty plaques inside their blood vessels, especially arteries. The plaque progresses with time and can block the aorta and iliac arteries in your pelvis. In that case, the blood supply to the tissue is compromised. Leg pain and the formation of skin ulcers are two common findings in patients with severe aortoiliac occlusive diseases.
For such patients, aortofemoral bypass surgery is indicated to develop a channel that will restore the blood flow to the limb. It reduces the likelihood of devastating outcomes such as amputation.
What is Aortofemoral Bypass Surgery?
Aortofemoral bypass surgery involves making a channel that bypasses the occlusive artery to re-establish the blood supply of the affected part of the leg. It usually involves cutting into your belly (tummy) and groins to use an artificial artery (surgical graft) to bypass your damaged arteries.
Endovascular intervention is currently the first-line surgical therapy for treating most vascular occlusive diseases. Patients with extensive disease in the aorta and groin arteries, on the other hand, may not be candidates for this minimally invasive surgery. In that case, bypass surgery will help maintain circulation in both legs.
What are the Indications?
Not all patients of the aortoiliac occlusive disease require bypass surgery. Therefore, it is usually indicated only in severe conditions involving any of the following.
- Non-healing foot ulcers associated with gangrene
- Critical limb ischemia and severe pain in the foot at night
- Severe claudication pain even after effective medical therapy
Are There Any Contraindications?
Although aortofemoral bypass surgery is essential in some patients to restore circulation to both legs, there are certain contraindications for this intervention. You have to adopt some other method to manage your disease.
- Patients who are at high risk for general anaesthesia
- Patients with a significant cardiac history and severe heart failure
- Patients with severe kidney disease will be at increased risk of kidney failure
- Patients who have had multiple abdominal surgeries in the past will be at higher risk of complications post this procedure
What Happens Before the Surgery?
In the Preoperative assessment clinic, your anesthesiologist will assess your health status, order some laboratory tests, and may ask for additional tests for your heart and chest. This is very important to determine whether you are fit for the procedure. You must bring all of your medications to your pre-op appointment with you.
Your surgeon will explain the procedure and its risks to you, and the final decision will be yours.
What Does the Surgery Involve?
Aortofemoral bypass surgery is an invasive procedure. You would need general anaesthesia, usually combined with epidural anaesthesia (a small tube in the back through which local anaesthetics are administered before, during, and after surgery). The advantage of epidural anaesthesia is that it can also be used for pain relief following surgery. After making the necessary arrangements, your surgeon will start the operation, which involves the following steps.
- He will incise your skin with a blade in three places. First, in the abdomen to expose the aorta. Second, both groins expose the femoral artery.
- He will insert a Y-shaped fabric tube into your abdomen using special equipment.
- He will sew the single arm of the tube with the aorta and the two arms of the tube with the femoral arteries, bypassing the point of occlusion.
- The fabric graft will now allow a channel to supply the blood to the legs.
- In the end, your surgeon will stitch the skin and apply the dressings.
How Does Recovery Occur?
Post-surgery you will be transferred to the intensive care unit for monitoring for 24-48h. Then, if all goes well, your surgeon will transfer you to the ward to get the proper care to help your recovery, including physiotherapy. Usually, you need to stay about five days in the hospital. Then, after your health status becomes stable, you will be able to go home.
At home, certain considerations would help you in your speedy recovery.
- Eat healthy food to get more energy.
- Try to walk daily. It’s better to start with short distances initially and then slowly increase the distance each day.
- Take the prescribed medications to prevent complications and to help relieve the pain.
Follow-up appointments will be arranged for you to assess your recovery and wound healing.
What are the Possible Complications?
Every surgical procedure presents some risk of complications. Furthermore, aortofemoral bypass surgery is an invasive procedure. Therefore, it comes with a higher risk of complications. Your surgeon will tell you all the possible risks of the surgery. The final decision is yours regarding whether you want to have the operation or not.
Bleeding, wound leakage, and wound infection are all possibilities. Furthermore, severe complications such as heart attack, pulmonary embolism leading to respiratory problems, and kidney failure can occur, resulting in death in approximately 3% of patients. Patients are also at risk of late complications such as hernias, graft blockage, and infection.
