The inner wall of the arteries is lined by a thin layer of cells which ensures that the lining remains smooth and allows for unobstructed flow of blood. With aging, plaque which is made up of cholesterol, calcium or fibrous tissue starts building up on the inner walls of your artery. The accumulation of these atherosclerotic plaques in the artery make it narrow and stiff. Eventually the blood flow is blocked due to atherosclerosis and this results in decreased supply of oxygen to your organs and muscles. This condition can be successfully treated with surgical bypass. Surgical bypass involves rerouting blood around a section of the artery that is blocked.
Surgical bypass is a treatment option reserved for patients with advanced atherosclerosis where there is risk of losing the leg with no intervention. Often this is the only choice left to improve the blood supply to the leg when keyhole endovascular options have already failed.
Before surgery, your physician checks your general health, medical history, and symptoms. In addition to this, duplex ultrasound, magnetic resonance angiography or computerised tomographic angiography may be recommended to determine the extent of arterial involvement for pre-operative planning.
Bypass surgery is performed under general or regional anaesthesia depending on your overall fitness level and after discussion with the anaesthetists. In most instances the tube chosen for the bypass procedure is your own vein which is harvested from the leg and in some cases an artificial tube made of medical grade PTFE. The surgeon initially harvests the vein from the leg (usually the same leg undergoing bypass) by making an incision along the inside of the thigh. After this, the surgeon exposes the artery above and below the level at which the artery is blocked. Next a blood thinner (Heparin) is administered to ensure that the blood remains thin and prevents clots from forming whilst the blood is temporarily blocked for the surgery. Clamps are placed at each end of the blocked section of artery to ensure that the there is no blood loss during the bypass procedure. Next the graft is sutured in carefully using very fine sutures after tunnelling it under the skin and muscles of the thigh. The blood flow is then restored and the suture lines are checked by the surgeon to ensure that it holds. An angiogram maybe performed to confirm that the graft is working properly. Following this the surgeon closes the incision with stitches.
After surgery, you will have to stay in hospital for 3-10 days for monitoring. You should contact your physician immediately if you develop a fever, cold painful leg or if the skin over the incision and surrounding becomes red or swollen. You can resume your physical activities only as per your doctor’s advice. You will be asked to meet your doctor for follow-up visits and will have to take prescribed medications regularly
As with any surgical procedure, surgical bypass carries risks such as bleeding from the suture line, graft blocking, wound healing problems, infections and also major amputation.