35663 Bypass graft, with other than vein; ilioiliac

Name of the Procedure:

Bypass Graft, with Other than Vein; Ilioiliac
Common Name(s): Ilioiliac Bypass, Ilioiliac Arterial Graft

Summary

An ilioiliac bypass graft is a surgical procedure that involves bypassing a blocked or narrowed artery in the pelvis, specifically the iliac arteries, which supply blood to the legs. Instead of using a vein, another type of graft material is used to create an alternate pathway for blood flow.

Purpose

This procedure is primarily performed to restore proper blood flow to the lower extremities when the iliac arteries are obstructed. The main goals are to reduce symptoms such as pain and cramping in the legs (claudication), prevent tissue damage, and improve overall blood circulation.

Indications

• Severe peripheral artery disease (PAD) affecting the iliac arteries.
• Critical limb ischemia causing pain, non-healing wounds, or ulcers.
• Ineffectiveness of less invasive treatments such as medication or lifestyle changes.
• Patients who have had previous vascular surgeries that have failed.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to medications, including stopping blood thinners as advised.
• Pre-operative imaging studies like a CT angiogram or MR angiogram to assess the blood vessels.
• General health assessment and lab tests to ensure the patient is fit for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen or groin area to access the iliac arteries.
3. A graft made of synthetic material (e.g., Dacron or PTFE) is sewn into place to bypass the blocked section of the artery.
4. Blood flow is redirected through the new graft.
5. Incisions are closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes around 2 to 4 hours, depending on the complexity and patient's medical condition.

Setting

This surgery is performed in a hospital's operating room.

Personnel

• Vascular Surgeon
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Graft failure or blockage
• Injury to surrounding organs or tissues
• Complications from anesthesia
• Delayed wound healing or scar formation

Benefits

• Improved blood flow to the lower extremities
• Relief from symptoms such as leg pain and cramping
• Prevention of limb-threatening complications like gangrene
• Enhanced mobility and quality of life
• Benefits are typically realized within a few weeks post-procedure.

Recovery

• Hospital stay of approximately 3 to 7 days.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments to monitor recovery and graft function.
• Gradual return to normal activities over 4 to 6 weeks, avoiding heavy lifting or strenuous exercise during this time.

Alternatives

• Angioplasty with or without stent placement
• Medical management with medications to improve blood flow
• Lifestyle changes such as exercise and smoking cessation
• Endarterectomy (removal of plaque from the artery)

Pros of Alternatives:

• Less invasive options might be preferred initially.
• Shorter recovery times for some procedures.

Cons of Alternatives:

• May not be effective for severe blockages.
• Higher risk of re-narrowing or blockage.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, patients may experience discomfort at the surgical site, managed with pain medications. They might feel tired and need support with daily activities initially. Ensuring comfort measures and following medical advice is critical for a smooth recovery.