35506 Bypass graft, with vein; carotid-subclavian or subclavian-carotid

Name of the Procedure:

Bypass graft, with vein; carotid-subclavian or subclavian-carotid
Common Names: Carotid-subclavian bypass, Subclavian-carotid bypass
Medical Terms: Carotid-subclavian graft, Subclavian-carotid vein graft

Summary

The bypass graft procedure involves using a vein from another part of the body to create a new pathway for blood to flow between the carotid and subclavian arteries. This helps maintain proper blood circulation when one of these arteries is blocked or narrowed.

Purpose

The procedure addresses the issue of blocked or narrowed carotid or subclavian arteries, which can hinder blood flow to the brain, arms, or other parts of the body. The goal is to improve blood circulation, reduce the risk of stroke, and alleviate symptoms like dizziness, arm claudication, or ischemic pain.

Indications

• Blockage or significant narrowing of the carotid or subclavian artery
• Symptoms such as dizziness, arm pain, or stroke-like symptoms
• Special criteria: Patients who have not responded well to other treatments like medication management or less invasive procedures

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to medications, particularly blood thinners, as advised by the doctor
• Pre-procedure diagnostic tests such as ultrasounds, CT angiograms, or MR angiograms to assess the condition of the arteries

Procedure Description

1. Anesthesia: The patient is given general anesthesia for comfort and to ensure immobility.
2. Incision: The surgeon makes an incision near the neck or clavicle to access the carotid and subclavian arteries.
3. Harvesting Vein: A suitable vein, often from the leg, is harvested to be used as the graft.
4. Grafting: The vein is sewn into place to create a new pathway, bypassing the blocked or narrowed artery.
5. Closure: The incisions are closed with sutures, and sterile dressings are applied.

Duration

Typically, the procedure takes about 2 to 4 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Operating room nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Common risks: Infection, bleeding, and blood clots
• Rare complications: Stroke, damage to nerves or surrounding structures, graft failure
• Management strategies include close monitoring, medications, and potentially additional interventions

Benefits

• Improved blood flow to the brain and arms
• Reduction in symptoms like dizziness and ischemic pain
• Decreased risk of stroke

Recovery

• Hospital stay: Typically 1 to 3 days
• Post-procedure care: Wound care, pain management, and activity restrictions
• Follow-up appointments: Scheduled to monitor the graft and overall recovery
• Recovery time: Most patients can resume normal activities within 4 to 6 weeks

Alternatives

• Medical management with medications
• Balloon angioplasty and stenting
• Carotid endarterectomy
• Each alternative has its own risks and benefits that should be discussed with a healthcare provider

Patient Experience

• During: As the procedure is performed under general anesthesia, the patient will not feel or experience any pain during the operation.
• After: Pain and discomfort at the incision sites, managed with prescribed pain medication
• Recovery: Patients are encouraged to gradually return to their regular activities and attend all follow-up appointments to ensure proper healing and graft function.