This procedure is performed to improve the circulation in the legs. It may be performed for pain on walking called “claudication”, which restricts the walking distance. Alternatively, it may be performed when circulation is critical resulting in pain at rest, ulceration or even gangrene.
What investigations are carried out?
An x-ray of the blood vessels called an “angiogram” is ordered to determine whether the operation is possible and how best to perform it.
In order to perform the bypass procedure it is best to use one of the patient’s own veins for the bypass. A duplex ultrasound scan of your legs may be required to determine this.
What is involved with the operation?
A week in hospital and four weeks recovering from the procedure are required. Admission to hospital occurs on the day of the procedure with blood tests and an Electrocardiogram (ECG) performed. The anaesthetist will see the patient on the Ward prior to operation and will explain the anaesthetic risks of the procedure.
The operation will be performed under either a general anaesthetic or spinal anaesthetic. This decision is usually made by the anaesthetist in consultation with the patient.
A long incision is made on the inside of the leg to recover the vein, which can then be used to perform the bypass. The bypass is usually performed from the groin to the knee, though this may vary depending on the precise site of the arterial blockages. Occasionally a synthetic bypass is used if your vein is unsuitable.
Following the procedure, patients return to the Ward for observation.
What happens after the operation?
The Nursing Staff will make regular observations to ensure that the bypass has been successful. A doppler study will be performed within 24 hours of the procedure to confirm the bypass graft is functioning optimally.
A Catheter is inserted into the bladder at the time of surgery, but is usually removed within 24 hours. There may be drains in the wounds, which are also removed within 24-48 hours.
Patients will be able to sit out of bed the day after the procedure and walking will commence on Day 2. Hopefully by the end of the week, sufficiently mobile to be allowed home.
Swelling of the leg is a frequent occurrence and may be controlled with an elastic stocking. This will be provided by the Nursing Staff on the Ward.
If skin clips are used to close the wound, these will usually be removed prior to discharge.
Are there any potential complications?
Potential complications associated with the anaesthetic will be explained to you by the Anaesthetist.
It is possible that the graft may block at any time. If this occurs, the circulation will deteriorate significantly and the graft may need to be unblocked. Occasionally a further operation is required to restore flow through the graft. On rare occasions, if the graft cannot be unblocked, the degree of circulatory impairment may be severe resulting in amputation. Bleeding from the graft or the wound may occur.
Less severe complications include wound infection or fluid collections, most frequently in the groin. These usually respond favourably to local treatment and antibiotics.
What should I do when I get home?
Whilst encouraged to walk, patients should attempt to remain within their comfort zone at all times. If swelling of the leg is a problem, wear the stockings and try to keep the leg elevated as much as possible. If not progressing as well as expected please contact the Main Office.
Patients should return for review 2 weeks after the operation. No driving before that time.