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Peripheral vascular bypass surgery

Definition

A peripheral vascular bypass, also called a lower extremity featherbed, is the surgical rerouting of claret flow around an obstructed artery that supplies blood to the legs and feet. This surgery is performed when the buildup of fatty deposits (plaque) in an artery has blocked the normal menses of blood that carries oxygen and nutrients to the lower extremities. Featherbed surgery reroutes blood from above the obstructed portion of an avenue to some other vessel below the obstruction.

A bypass surgery is named for the artery that will be bypassed and the arteries that volition receive the rerouted blood. The three common peripheral vascular bypass surgeries are:

Aortobifemoral featherbed surgery, which reroutes blood from the abdominal aorta to the two femoral arteries in the groin.
Femoropopliteal bypass (fem-pop bypass) surgery, which reroutes blood from the femoral artery to the popliteal arteries higher up or beneath the knee.
Femorotibial bypass surgery, which reroutes claret between the femoral artery and the tibial avenue.

A substitute vessel or graft must be used in bypass surgeries to reroute the blood. The graft may be a healthy segment of the patient's ain saphenous vein (autogenous graft), a vein that runs the unabridged length of the thigh. A synthetic graft may be used if the patient'southward saphenous vein is not healthy or long enough, or if the vessel to be bypassed is a larger artery that cannot be replaced past a smaller vein.

Purpose

Peripheral vascular bypass surgery is performed to restore blood flow (revascularization) in the veins and arteries of people who accept peripheral arterial disease (PAD), a form of peripheral vascular disease (PVD). People with PAD develop widespread hardening and narrowing of the arteries (atherosclerosis) from the gradual build-upward of plaque. In advanced PAD, plaque accumulations (atheromas) obstruct arteries in the lower abdomen, groin, and legs, blocking the flow of blood, oxygen, and nutrients to the lower extremities (legs and feet). Rerouting blood flow around the blockage is one style to restore circulation. Information technology relieves symptoms in the legs and anxiety, and helps avoid serious consequences such as centre assault, stroke, limb amputation , or decease.

Demographics

Approximately eight–10 million people in the United States have PAD acquired by atherosclerosis. These people are at high adventure of arterial occlusion, and are candidates for peripheral vascular bypass surgery. Occlusive arterial affliction is found in xv–20% of men and women older

In this femoropopliteal bypass, a portion of the saphenous vein can be removed and used to bypass a portion of a diseased avenue. To reach this, an incision is made downward the within of the leg (A). The saphenous vein is tied off from its tributaries and removed (B). An incision is made in the recipient artery (C), and the vein is stitched to information technology at the tiptop and bottom of the leg (D). (

Illustration by GGS Inc.

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than age 70. In people younger than age lxx, it occurs more often in men than women, peculiarly in those who have always smoked or who have diabetes. Women with PAD live longer than men with the same status, bookkeeping for the equal incidence in older Americans. African-Americans are at greater risk for arterial occlusion than other racial groups in the United States.

Description

The circulatory organization delivers blood, oxygen, and vital nutrients to the limbs, organs, and tissues throughout the trunk. This is achieved via arteries that deliver oxygen-rich blood from the heart to the tissues and veins that render oxygen-poor blood from organs and tissues back to the centre and lungs for re-oxygenation. In PAD, the gradual aggregating of plaque in the inner lining (endothelium) of the artery walls results in widespread atherosclerosis that can occlude the arteries and reduce or cutting off the supply of blood, oxygen, and nutrients to organ systems or limbs.

Peripheral vascular bypass surgery is a treatment option when PAD affects the legs and feet. PAD is similar to coronary avenue disease (CAD), which leads to heart attacks and carotid artery illness (CAD), which causes stroke. Atherosclerosis causes each of these diseases. Most ofttimes, atherosclerotic blockage or narrowing (stenosis) occurs in the femoral arteries that supply the thighs with blood or in the mutual iliac arteries, which are branches of the lower abdominal aorta that also supplies the legs. The popliteal arteries (a portion of the femoral arteries near the surface of the legs) or the posterior tibial and peroneal arteries below the knee (portions of the popliteal artery) tin can be affected.

Just as coronary avenue disease tin can cause a center attack when plaque blocks the arteries of the heart, or blockage in the carotid avenue leading to the brain can cause a stroke, occlusion of the peripheral arteries can create life-threatening weather. Plaque aggregating in the peripheral arteries blocks the menses of oxygen-carrying claret, causing cells and tissue in the legs and anxiety to die from lack of oxygen (ischemia) and diet. Normal growth and prison cell repair cannot take place, which tin lead to gangrene in the limbs and subsequent amputation. If pieces of the plaque break off, they tin can travel from the legs to the heart or brain, causing heart set on, stroke, or expiry.

The development of atherosclerosis and PAD is influenced by heredity and also past lifestyle factors, such as dietary habits and levels of exercise . The take a chance factors for atherosclerosis include:

high levels of blood cholesterol and triglycerides.
loftier blood pressure (hypertension)
cigarette smoking or exposure to tobacco smoke
diabetes, types 1 and 2
obesity
inactivity, lack of exercise
family history of early cardiovascular disease

Sometimes the torso will endeavour to alter the catamenia of blood when a portion of an avenue is narrowed by plaque. Smaller arteries around the blockage brainstorm to take over some of the claret flow. This adaptation of the body (collateral circulation) is i reason for the absence of symptoms in some people who have PAD. Another reason is that plaque develops gradually as people age. Symptoms usually don't occur until a blockage is over 70%, or when a piece of plaque breaks off and blocks an artery completely. Blockage in the legs reduces or cuts off circulation, causing painful cramping during walking, which is relieved on rest (intermittent claudication). The feet may ache fifty-fifty when lying down at night.

When narrowing of an artery occurs gradually, symptoms are not as severe as they are when sudden, complete blockage occurs. Sudden blockage does not permit time for collateral vessels to develop, and symptoms can be severe. Gradual blockage creates musculus aches and hurting, cramping, and sensations of fatigue or numbness in the limbs; sudden blockage may cause severe hurting, coldness, and numbness. At times, no pulse tin be felt, a leg may get blue (cyanotic) from lack of oxygen, or paralysis may occur.

When the lower aorta, femoral avenue, and common iliac arteries (all in the lower abdominal and groin areas) are blocked, gradual narrowing may produce cramping hurting and numbness in the buttocks and thighs, and men may go impotent. Sudden blockage volition cause both legs to go painful, pale, common cold, and numb, with no pulse. The feet may become painful, infected, or even gangrenous when gradual or complete blockage limits or cuts off circulation. Feet may become purple or red, a condition called rubor that indicates severe narrowing. Pain in the feet or legs during rest is viewed as an indication for bypass surgery because circulation is reduced to a degree that threatens survival of the limb.

Early treatment for PAD usually includes medical intervention to reduce the causes of atherosclerosis, such as lowering cholesterol and blood pressure, smoking cessation , and reducing the likelihood of clot formation. When these measures are not constructive, or an artery becomes completely blocked, lower extremity featherbed surgery may be performed to restore circulation, reduce foot and leg symptoms, and prevent limb amputation.

Bypass surgery is an open procedure that requires full general anesthesia. In femoropopliteal bypass or femorotibial featherbed, the surgeon makes an incision in the groin and thigh to expose the afflicted avenue above the blockage, and another incision (backside the genu for the popliteal avenue, for case) to expose the artery below the blockage. The arteries are blocked off with vascular clamps. If an autogenous graft is used, the surgeon passes a dissected (cut and removed) segment of the saphenous vein along the artery that is being bypassed. If the saphenous vein is not long plenty or is non of good quality, a tubular graft of synthetic (prosthetic) material is used. The surgeon sutures the graft into an opening in the side of one artery and and then into the side of the other. In a femoropopliteal bypass, for instance, the graft extends from the femoral artery to the popliteal artery. The clamps are then removed and the flow of blood is observed to make sure information technology bypasses the blocked portion of the affected artery.

Aortobifemoral bypass surgery is conducted in much the same mode, although it requires an abdominal incision to access the lower portion of the abdominal aorta and both femoral arteries in the groin. This is generally a longer and more difficult procedure. Synthetic grafts are used considering the lower abdominal aorta is a large conduit, and its blood menses cannot be handled by the smaller saphenous vein. Vascular surgeons prefer the saphenous vein graft for femoropopliteal or femorotibial bypass surgery because it has proven to stay open and provide meliorate performance for a longer catamenia of time than synthetic grafts. Bypass surgery patients volition exist given heparin, a blood thinner, immediately later the surgery to prevent clotting in the new bypass graft.

Diagnosis/Training

Diagnosis

Later on obtaining a detailed history and reviewing symptoms, the doctor examines the legs and feet, and orders appropriate tests or procedures to evaluate the vascular system. Diagnostic tests and procedures may include:

Claret force per unit area and pulses—pressure measurements are taken in the arms and legs. Pulses are measured in the arms, armpits, wrists, groin, ankles, and behind the knees to determine where blockages may exist, since no pulse is usually felt below a blockage.
Doppler ultrasonography—direct measurement of blood menstruation and rates of menstruation, sometimes performed in conjunction with stress testing (tests that incorporate an exercise component).
Angiography—an x ray procedure that provides clear images of the affected arteries earlier surgery is performed.
Blood tests—routine tests such every bit cholesterol and glucose, as well every bit tests to aid place other causes of narrowed arteries, such every bit inflammation, thoracic outlet syndrome, high homocycteine levels, or arteritis.
Spiral computed tomography (CT angiography ) or magnetic resonance angiography (MRA)—less invasive forms of angiography.

Preparation

If not done before in the diagnostic procedure, ultrasonography or angiography procedures may be performed when the patient is admitted to the hospital. These tests aid the physician evaluate the amount of plaque and exact location of the narrowing or obstacle. Any underlying medical status, such as high blood force per unit area, middle affliction, or diabetes is treated prior to bypass surgery to assistance obtain the all-time surgical result. Regular medications, such as blood pressure drugs or diuretics , may be discontinued in some patients. Routine pre-operative blood and urine tests are performed when the patient is admitted to the hospital.

Aftercare

Later on bypass surgery, the patient is moved to a recovery area where blood force per unit area, temperature, and heart rate are monitored for an 60 minutes or more. The surgical site is checked regularly. The patient is and so transferred to a concentrated care unit to be observed for whatever signs of complications. The total hospital stay for femoropopliteal bypass or femorotibial bypass surgery may be 2 to four days. Recovery is slower with aortobifemoral bypass surgery, which involves intestinal incisions, and the hospital stay may extend up to a calendar week. Walking will begin immediately for patients who take had femoropopliteal or femorotibial bypasses, but patients who accept had aortobifemoral bypass may exist kept in bed for 48 hours. When bypass patients go home, walking more each day, every bit tolerated, is encouraged to help maintain blood catamenia and musculus force. Anxiety and legs can be elevated on a footstool or pillow when the patient rests. Some swelling of the leg should be expected; it does non point a trouble and will resolve inside a month or two.

During recuperation, the patient may be given pain medication if needed, and clot prevention (anticoagulant) medication. Any redness of the surgical site or other signs of infection will be treated with antibiotics . Patients are advised to reduce the gamble factors for atherosclerosis in club to avoid repeat narrowing or blockage of the arteries. Repeat stenosis (restenosis) has been shown to occur frequently in people who do not make the necessary lifestyle modifications, such as changes in diet, practice, and smoking abeyance. The benefits of the featherbed surgery may only be temporary if underlying disease, such as atherosclerosis, high claret pressure, or diabetes, is not also treated.

Risks

The risks associated with peripheral vascular bypass surgery are related to the progressive atherosclerosis that led to arterial occlusion, including a render of pre-operative symptoms. In patients with advanced PAD, heart attack or heart failure may occur. Build up of plaque has likewise taken place in the patient's arteries of the heart. Restenosis, the continuing build up of plaque, can occur inside months to years after surgery if take chances factors are not controlled. Other complications may include:

clot germination in a saphenous vein graft
failed grafts or blockages in grafts
reactions to anesthesia
animate difficulties
embolism (clot from the surgical site traveling to vessels in the heart, lungs, or encephalon)
changes in claret pressure
infection of the surgical wound
nerve injury (including sexual part impairment afterwards aortobifemoral bypass)
post-operative bleeding
failure to heal properly

Normal results

A femoropopliteal or femorotibial bypass with an autogenous graft of good quality saphenous vein has been shown to accept a 60–70% take a chance of staying open up and functioning well for five to ten years. Aortobifemoral bypass grafts have been shown to stay open up and reduce symptoms in fourscore% of patients for up to ten years. Pain and walking difficulties should be relieved afterwards bypass surgery. Success rates improve when the underlying causes of atherosclerosis are monitored and managed finer.

Morbidity and bloodshed rates

The run a risk of decease or heart attack is nearly 3–5% in all patients undergoing peripheral vascular featherbed surgery. Post-obit bypass surgery, amputation is withal an effect in about twoscore% of all surgeries performed, usually due to progressive atherosclerosis or complications acquired by the patient'south underlying disease condition.

Alternatives

Peripheral vascular featherbed surgery is a mechanical way to reroute claret, and there is no alternative method. Alternative ways to prevent plaque build-up and reduce the risk of narrowing or blocking the peripheral arteries include nutritional supplements and alternative therapies, such as:

Folic acid tin help lower homocysteine levels and increment the oxygen-carrying capacity of cherry claret cells.
Vitamins B _six and B ₁₂ tin can aid lower homocysteine levels.
Antioxidant vitamins C and Due east work together to promote good for you blood vessels and improve circulation.
Angelica, an herb that contains coumadin, a recognized anticoagulant, which may assistance forestall clot formation in the blood.
Essential fatty acids, as found in flax seed and other oils, to help reduce blood pressure and cholesterol, and maintain blood vessel elasticity.
Chelation therapy, used to interruption up plaque and improve circulation.

Resource

books

Cranton, Elmer Chiliad.D., ed. Bypassing Bypass Surgery: Chelation Therapy: A Non-Surgical Treatment for Reversing Arteriosclerosis, Improving Blocked Circulation, and Slowing the Aging Process. Hampton Roads Pub. Co., 2001.

McDougal, Gene. Unclog Your Arteries: How I Beat out Atherosclerosis. 1st Books Library, 2001.

organizations

American Heart Association (AHA). 7272 Greenville Ave., Dallas, TX 75231. (800) 242-8721. http://www.americanheart.org .

Vascular Illness Foundation. 3333 Southward Wadsworth Blvd. B104-37, Lakewood, CO 80227. (303) 949-8337 or (866)PADINFO (723-4636). http://www.vdf.org .

other

Featherbed Surgery for Peripheral Arterial Affliction. Patient Data, Vascular Illness Foundation, 2003. http://www.vdf.org.

Hirsch, G.D., Alan T. "Occlusive Peripheral Arterial Disease." The Merck Manual of Medicine—Home Edition, Center and Blood Vessel Disorders 34:3. http://www.merck.com/pubs .

Fifty. Lee Canal

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Peripheral vascular bypass surgery is performed past a vascular surgeon in a hospital operating room .

QUESTIONS TO ASK THE Md

Why is this surgery necessary?
How volition the surgery improve my condition?
What kind of anesthesia volition be given?
How many of these procedures has the surgeon performed?
How many surgical patients had complications later the procedure?
How tin can the patient look to feel later surgery?
How shortly will the patient exist able to walk?
How long will it accept to recover completely?
What are the chances of this problem recurring after surgery?
What tin be washed to help prevent this problem from developing again?

Source: https://www.surgeryencyclopedia.com/Pa-St/Peripheral-Vascular-Bypass-Surgery.html

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