01656 Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft

Name of the Procedure:

Anesthesia for Procedures on Arteries of Shoulder and Axilla; Axillary-Femoral Bypass Graft

Summary

The procedure involves administering anesthesia to facilitate a surgical operation where a graft is placed between the axillary artery and the femoral artery to bypass a blockage and improve blood flow.

Purpose

The procedure addresses arterial blockages or severe narrowing in the upper and lower parts of the body. The goal is to restore proper blood circulation and alleviate symptoms such as pain and muscle cramps. It aims to improve the patient's quality of life and reduce the risk of serious complications like limb loss.

Indications

This procedure is indicated for patients with:

• Severe atherosclerosis resulting in arterial blockages
• Peripheral artery disease that has not responded to conservative treatments
• Symptoms like severe pain, claudication (limping pain due to arterial blockages), or non-healing wounds

Preparation

Patients may be advised to:

• Fast for at least 8 hours before the procedure
• Stop certain medications as directed by their healthcare provider
• Undergo diagnostic tests like blood work, imaging studies (e.g., MRI, CT scan), and a detailed medical evaluation

Procedure Description

1. The patient is positioned on the operating table, and monitors are attached to track vital signs.
2. An anesthesiologist administers general or regional anesthesia to ensure the patient is comfortable and pain-free.
3. A vascular surgeon makes an incision near the axillary artery in the shoulder area and the femoral artery in the groin.
4. A synthetic graft or vein harvested from the patient's own leg is used to connect the axillary artery to the femoral artery, creating a bypass around the blocked segment.
5. The incisions are closed with sutures or staples, and sterile dressings are applied.

Tools and Equipment: Scalpel, surgical clamps, graft materials, sutures, anesthetic drugs, and vital signs monitors.

Anesthesia: General anesthesia (rendering the patient unconscious) or regional anesthesia (numbing a specific area of the body).

Duration

The procedure typically takes about 2 to 4 hours, depending on the complexity of the case.

Setting

This procedure is performed in a hospital operating room with full surgical and anesthesia capabilities.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians
• Post-Anesthesia Care Unit (PACU) Nurses

Risks and Complications

• Common risks: bleeding, infection, and adverse reactions to anesthesia
• Rare risks: blood clots, graft failure, nerve damage, and complications related to underlying health conditions
• Management: Close monitoring, use of antibiotics, blood thinners, and prompt intervention if complications arise

Benefits

• Improved blood flow to the affected limbs
• Reduction in pain and other symptoms
• Potentially improved healing of wounds and ulcers
• Enhanced overall mobility and quality of life

Recovery

• Post-procedure monitoring in the recovery room
• Pain management with prescribed medications
• Instructions to avoid strenuous activities during the initial recovery period
• Follow-up appointments for wound care and graft assessment
• Full recovery may take several weeks, with gradual resumption of normal activities

Alternatives

• Angioplasty and stenting: less invasive but may not be suitable for extensive blockages
• Medication management: may control symptoms but not address severe blockages effectively
• Amputation: considered in extreme cases when other interventions fail

Pros and Cons:

• Angioplasty and stenting: minimally invasive but less durable
• Medication: low risk but may have limited effectiveness
• Amputation: prevents severe complications in critical cases but highly invasive and life-altering

Patient Experience

During the procedure, the patient will be either unconscious or numb in the affected areas. Post-surgery, there may be some discomfort or pain managed through medications. Recovery involves taking it easy, following wound care instructions, and attending follow-up visits to ensure proper healing and graft function.