35646 Bypass graft, with other than vein; aortobifemoral

Name of the Procedure:

Bypass Graft, with other than vein; Aortobifemoral
Common names: Aortobifemoral Bypass, Aorto-femoral Bypass Graft
Medical term: Aortobifemoral Bypass Graft with Prosthetic Material

Summary

An aortobifemoral bypass graft is a surgical procedure to treat severe atherosclerosis in the abdominal aorta and iliac arteries. It involves creating a detour around blocked blood vessels using a synthetic graft to restore proper blood flow to the lower limbs.

Purpose

Medical Condition: Atherosclerosis, Peripheral Arterial Disease (PAD)
Goals: To reestablish adequate blood flow to the legs, relieve symptoms like pain and cramping, and prevent limb loss. The expected outcome is improved mobility and quality of life.

Indications

• Severe peripheral arterial disease with significant pain (claudication) or limb-threatening ischemia.
• Non-healing ulcers or gangrene due to poor blood supply.
• Patients who have not responded adequately to lifestyle changes, medication, or less invasive interventions.

Preparation

• Fasting: Typically required for 8 hours before the surgery.
• Medications: Adjustments or discontinuation of certain medications, especially blood thinners, as advised by the doctor.
• Diagnostics: Pre-operative imaging studies like Doppler ultrasound, CT angiography, or MR angiography to assess the extent of arterial narrowing or blockage.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incisions: Surgical cuts are made in the abdomen to access the aorta and in the groin to access the femoral arteries.
3. Exposure and Clamping: The aorta and femoral arteries are exposed, and clamps are applied to control blood flow.
4. Graft Placement: A synthetic graft (usually made of materials like Dacron) is attached to the aorta below the renal arteries and then divided into two limbs that are connected to the femoral arteries in the groin.
5. Restoration of Blood Flow: Once secured, the clamps are removed to allow blood to flow through the new graft.
6. Closure: The incisions are sutured closed, and sterile dressings are applied.

Tools: Surgical instruments, synthetic graft material, clamps, sutures.
Anesthesia: General anesthesia.

Duration

Approximately 3-5 hours, depending on the complexity of the case and the patient's condition.

Setting

Performed in a hospital surgical suite or operating room.

Personnel

• Surgeon: Specializing in vascular surgery.
• Anesthesiologist: Manages sedation and pain control.
• Nurses: Assist during surgery and in post-operative care.
• Surgical Technicians: Assist in the operating room.

Risks and Complications

• Common Risks: Infection, bleeding, reaction to anesthesia, blood clots.
• Rare Complications: Graft failure, kidney damage, complications related to heart or lungs, limb loss. Management of complications may involve additional surgery or medical interventions.

Benefits

• Improved blood flow to the lower extremities.
• Relief from pain and cramping during walking.
• Enhanced mobility and quality of life.
• Decreased risk of limb loss from severe ischemia.

Recovery

• Post-Procedure Care: Monitoring in the intensive care unit (ICU) immediately after surgery.
• Instructions: Pain management, wound care, avoiding strenuous activities, and gradually increasing physical activity.
• Recovery Time: Generally, 4-6 weeks to return to normal activities.
• Follow-Up: Regular check-ups with the surgeon and possibly imaging tests to assess graft function.

Alternatives

• Endovascular Procedures: Such as angioplasty and stenting. Less invasive but may not be suitable for extensive disease.
• Medications and Lifestyle Changes: For less severe PAD.
• Amputation: In severe cases where revascularization is not feasible. Pros/Cons: Endovascular procedures have quicker recovery but less durability. Medications and lifestyle changes are non-invasive but often less effective for severe disease.

Patient Experience

• During Procedure: Patient is under general anesthesia and will not feel any pain during the surgery.
• After Procedure: Expect some pain and discomfort at the incision sites, which is managed with prescribed pain medications.
• Pain Management: Pain relief through medications and careful monitoring. Gradual improvement in symptoms as recovery progresses. Comfort measures include adequate rest, proper wound care, and support from healthcare staff.