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Disease Information : PAD : Treatment : Bypass Surgery for PAD

Bypass Surgery for PAD

What is bypass grafting?

Bypass grafting is the rerouting the blood from above an obstruction in the artery to below an obstruction. Bypass is the most common surgical technique used to treat PAD. Bypasses have names that describe the artery above the blockage and the artery below the blockage. Examples would be:

Since bypass grafting is a rerouting of the blood flow, a tube (graft or conduit) is required to carry the blood. Sometimes the patientпїЅs veins are used.

The type of conduit used depends on the location of the bypass graft. For bypasses in the pelvis (aortobifemoral) artificial material works best because these are large arteries requiring large conduits. There are no readily available veins of the correct size to use. For bypasses down the leg, artificial conduit is used as long as the bypass graft does not have to cross the knee. However, bypasses below the knee work best with the patientпїЅs own vein, preferably the saphenous vein (the same vein from the inner leg that heart surgeons use to bypass the heart blood vessels during open heart surgery).

What other things do I need to know about bypass surgery?

1. Placing a bypass permanently changes the artery structure of the leg. That often means that if the bypass clots off, the patient may have worse symptoms than before it was placed. This could include symptoms that become so severe that without another bypass, the patient may lose their leg and require an amputation.

2. All bypasses have an expected patency (time while the bypass remains open and continues to function) that is measured from 5 to 15 years. Bypasses in the pelvis usually have the best results. In general, the farther down the leg a surgeon has to go to bypass an obstruction, the shorter the patency of the bypass.

3. Bypass operations in older patients with PAD can pose more risks in addition to clotting off and not functioning. These risks include death from various causes, most often heart attack (usually occurs in the days following the operation). In general, the risk of death is one in twenty, although younger patients have less risk and older patients may have greater risk.

4. Leg complications are more common, including infections and breakdown of incisions. The vast majority of these will eventually heal, but it may take weeks or months. Many patients will have swelling of the operated leg, which can be severe. The swelling often gets better with time, but mild permanent swelling is common.

What type of follow-up care will I need?

Bypasses have a much better chance of long-term success if the surgeon continues to supervise the patient periodically in a clinic. The bypass must be monitored with physical examinations and ultrasound to make sure it does not narrow in spots -- narrowing can occur without any symptoms. If the surgeon is able to detect this narrowing, it can usually be repaired with either balloon techniques or a small surgery. If it is allowed to progress and block off the bypass completely, then the patient may lose their leg or require a large operation (see 1 above).

Peripheral Arterial Disease section was last modified: December 21, 2010 - 06:12 pm

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