1.What is bypass surgery?
Bypass surgery is a surgical procedure that bypasses the site of an arterial occlusion to directly create another pathway or bypass called a bypass to resolve the arterial stenosis or occlusion. Normally, the inside of your arteries are smooth and unblocked. When atherosclerosis, or hardening of the arteries, occurs, an occlusion forms inside the artery. As you age, a hard plaque, made up of cholesterol, calcium salts and fibrous tissue, forms on the inside of your arteries. As plaque forms, your arteries become narrow and stiff. Over time, as the lesion progresses, your arteries will not be able to provide enough oxygen to supply the needs of your organs or muscles, at which point symptoms appear.
During a bypass surgery, a vascular surgeon creates a new blood flow pathway using a tube, either your own vein or an artificial blood vessel. By connecting the upper and lower ends of the blockage, blood flow is redirected around the occluded section to the distal end.
You may have heard of heart bypass surgery, but vascular surgeons use a similar approach to treat peripheral vascular disease. Bypass surgery is most commonly used to treat lower extremity arterial disease, which is caused by hardening of the arteries in the lower extremities. Doctors also use bypass surgery for upper extremity disease and for occlusion of blood vessels anywhere in the body.
2.What do I need to prepare for the surgery?
First, the doctor will ask you about your general condition, medical history and symptoms. In addition, you will be examined and blood tests will be taken. The doctor will also ask you when your symptoms have occurred and how often they occur.
Next, your doctor will perform the following tests to identify the site of the occlusion and determine the site of the bypass surgery.
(1) Ultrasound, a non-invasive test that uses high-frequency sound waves to monitor blood flow in real time and to detect occlusion sites and other abnormalities.
(2) Enhanced MRI (MRA), which uses magnetic fields and radio waves to show the site of arterial occlusion.
(3) Enhanced CT (CTA), which shows the site of arterial occlusion through the application of contrast and X-rays.
(4) Arteriography, which shows the arterial vascular pattern by direct injection of contrast into the artery followed by an X-ray.
If you have upper or lower extremity arterial disease, your doctor will perform segmental manometry or pulse volume tracing of your extremity to determine the site of arterial stenosis or occlusion. If you have previous cardiovascular disease or chest pain, your doctor may recommend a cardiac stress test or coronary angiogram.
You will be given preoperative precautions, such as fasting, before surgery. Typically, you will be advised to abstain from food and water for 8 hours prior to surgery. In addition, you will be advised to reduce or stop taking medications that may increase the risk of bleeding and other complications.
3. Am I a candidate for bypass surgery?
If you have symptoms of atherosclerosis, you may need bypass surgery. Mild symptoms may include pain in the limb during activity, while severe symptoms may develop into an ulcer or gangrene that does not heal easily. Even if you are not a candidate for angioplasty or stenting, you may still be able to have bypass surgery.
4. What factors are associated with complications?
The following factors may increase the chance of complications.
(1) Hypertension.
(2) Obesity.
(3) Hypercholesterolemia.
(4) Coronary artery disease.
(5) Chronic obstructive pulmonary disease, such as emphysema.
(6) Chronic renal insufficiency.
(7) diabetes mellitus.
(8) Smoking.
5.How is the surgery procedure?
The specific surgical procedure will be determined by your symptoms, general health condition, and vascular lesions. The surgeon will consult with the anesthesiologist on whether to use general or local anesthesia (including spinal or spinal anesthesia).
If your saphenous vein is in good condition, the surgeon will prefer to use your own saphenous vein, which runs under the skin from the foot to the groin and is removed before the bypass. If your saphenous vein is in poor condition or no longer exists, your doctor will need to select another vein or artificial vessel for bypass.
In order to expose the diseased vessel to be bypassed, an incision is made in the skin above the artery, and once the artery is exposed, the doctor will evaluate the arterial pulsation at the disease-free site. By checking the pulsation at this site, the doctor can confirm that the artery is supplying enough blood to the distal end.
Next, the doctor will dissect the artery distal to the occluded segment, where the other end of the bridge will be anastomosed. After the anastomosis is complete, the surgeon makes a subcutaneous tunnel through the tunneller and anastomoses the other end of the bridge through the subcutaneous tunnel to the proximal artery that has been dissected. After the anastomosis is completed, the surgeon checks the bridge for patency and for blood leakage at both ends. Finally, the skin incision is closed. After the procedure is complete, the surgeon may reconfirm the patency of the bridge by performing an ultrasound Doppler or other non-invasive tests.
6.What should I expect after the surgery?
Your hospital stay will be approximately 3-10 days, and your doctor will usually remove your sutures 7-14 days after surgery. After discharge, if you develop fever, coldness in the affected limb, or redness or swelling at the incision site, or exudate, you should contact your surgeon immediately as this may be a precursor to infection or other problems.
If you are a patient with lower extremity ischemia, your surgeon will recommend antiplatelet medication such as aspirin, which can prevent blood clots from forming.
7.What complications can occur from the surgery?
There may be some complications after bypass surgery, but they are not common. Some complications are not serious and include swelling or inflammation of the incision site. Serious complications include blockage of the bridge after bypass, anastomotic bleeding, and infection. Before the surgery, your doctor will explain to you in detail about the risks and benefits of the surgery.
8.How do I stay healthy after surgery?
Bypass surgery does not control plaque formation, but after bypass surgery, you should make as many lifestyle changes as possible to keep the arterial bridge open. You should pay attention to the following factors that can help control blood pressure and slow down the process of atherosclerosis, including.
(1) A low-fat, low-cholesterol, low-calorie diet.
(2) Controlling blood cholesterol and lipid levels.
(3) Maintaining your ideal body weight.
(4) Regular aerobic exercise, such as brisk walking, for 20-30 minutes at least five times a week.
(5) Quit smoking.