Understanding Peripheral Arterial Bypass Surgery Vascular Institute ServicesServices

Understanding Peripheral Arterial Bypass Surgery

What is peripheral arterial disease?

Peripheral arterial disease or PAD refers to diseases of any of the blood vessels outside of the heart. PAD is a range of disorders that can affect the blood vessels in the legs, feet, arms, or hands.

The most common form of PAD is atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and lipids build up to form a substance called plaque that clogs the inside of the artery. This build-up causes a gradual narrowing of the artery, which will decrease the amount of blood flow. When the flow of blood decreases, it results in a decrease of oxygen supply to the extremity, which in turn may cause pain. When the arteries to the legs are affected, a common symptom is pain in the calf when walking. This is known as intermittent claudication.

Claudication is a term describing the discomfort in the leg muscles that occurs when walking. The discomfort most often is described as a cramp, but it may also be described as a burning sensation, an ache, or a feeling of heaviness in the leg. A common place to feel discomfort is in the calf muscle, though it may also occur in the thigh or buttock. Typically, a person with claudication will only be able to walk a short distance before the discomfort becomes so severe they must stop and rest. When they have rested until the pain is gone they may resume walking for a distance before having to stop and rest again. The distance a person is able to walk varies with the severity of the blockages. Most people with claudication do not experience leg discomfort when they are at rest.

How do we determine if you have arterial blockages?

There are some relatively simple tests that can be done to determine if the arterial blood flow in your legs is normal.

Segmental pressure test

In this non-invasive test the blood pressure at several points in your leg is checked using a blood pressure cuff and a Doppler, a microphone-like instrument. You may be asked to walk on a treadmill, following which your ankle pressure will be taken again to determine if the pressure decreased when you walked.

Ultrasound scan

This non-invasive scan produces images of arteries on a screen and is used to evaluate the blood flow, locate blockages, and measure the size of the artery.

Arteriogram

In this test dye is injected into the arteries while X-rays are taken. The dye lights up the arteries allowing the area of blockage to be accurately pinpointed.

How are arterial blockages treated?

The best treatment for PAD depends on a number of factors, including overall health, the location, size and cause of the blockage. In some cases, lifestyle changes can be enough to slow the progress and manage PAD. However, some patients will need surgical intervention to restore the blood flow to their legs. For that reason, your physician may recommend peripheral bypass surgery.

What is bypass surgery?

Rest, eat well, quit smoking, and walk or do the exercise recommended by your doctor. During your pre-operative visit, you will be instructed on special breathing exercises to help in your recovery. You will also be asked if you routinely take a blood thinner, such as an aspirin product or Coumadin. Several routine tests are done before surgery:

  • Chest X-ray
  • EKG
  • Blood tests

Make a list of any questions you have and be sure to ask your doctor before surgery. Prior to your surgery, you will receive specific instructions about the food you can have. Generally, you should have nothing to eat or drink after midnight before surgery. You may be instructed to shower with special soap. Some suggestions to help you prepare:

  • Pack a bag for the next five days
  • Do not bring any valuables
  • Bring a list of exact medication names and dosages
  • Bring your insurance cards to the hospital

What are the treatments?

The morning of surgery you may be given medication that will make you feel relaxed and drowsy. You will be taken to the operating room on a rolling bed and your nurse will tell your loved ones where to wait. The length of time you will be in surgery depends on what type of bypass you are having. Your surgeon will be able to give you an estimated time based on your particular case.

The goal of any treatment program will focus on reducing your number of risk factors and will usually include:

  • Exercise program
  • Reduction of fat and cholesterol in diet
  • Controlling diabetes and hypertension
  • Smoking cessation; if you are a smoker, it is absolutely essential that you stop

What happens prior to surgery?

The morning of surgery you may be given medication that will make you feel relaxed and drowsy. You will be taken to the operating room on a rolling bed and your nurse will tell your loved ones where to wait. The length of time you will be in surgery depends on what type of bypass you are having. Your surgeon will be able to give you an estimated time based on your particular case.

What are the risks?

As in all surgeries there are risks. There is some risk of stroke, bleeding, infection, heart attack, and death. After careful review of your medical history and a physical exam your surgeon will identify your risks.

How will I feel after surgery?

You will wake up in the recovery room and you may feel confused at first. It is normal to lose track of time. When you are awake you will either go to a hospital room or the Intensive Care Unit. Your family will be able to visit briefly. Be assured you are in caring, capable hands. You will be asked to breathe deeply and cough hard to clear any fluids from your lungs. Your surgeon may have ordered pain medication, so don't hesitate to let your care provider know if you are uncomfortable.

What can I do when I return home?

Most people are in the hospital from four to seven days. Your physician will let you know your expected length of stay. A home health nurse may come to your home after you are discharged. You may be instructed to make some changes in your lifestyle such as modifying your diet to reduce consumption of fat and cholesterol, and exercising daily. Your surgeon will see you after surgery, usually within two weeks. Call your doctor if:

  • The incision site bleeds
  • Your leg or incision site feels numb or cold
  • You have leg swelling that increases
  • You have sudden shortness of breath
  • You have fatigue, especially with a fever
  • You have pain or oozing at the incision site

Remember...

It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your vascular specialist. Early detection of circulatory problems is important for effective treatment.

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