35501 Bypass graft, with vein; common carotid-ipsilateral internal carotid

Name of the Procedure:

Bypass graft, with vein; common carotid-ipsilateral internal carotid

Summary

This surgical procedure involves creating a new path for blood to flow to the brain by using a section of vein to bypass a blocked or narrowed part of the carotid artery. The grafted vein connects the common carotid artery to the ipsilateral internal carotid artery.

Purpose

The procedure is designed to improve blood flow to the brain and reduce the risk of stroke by bypassing a blocked or narrowed carotid artery.

Indications

• Severe carotid artery disease or stenosis
• Symptoms of transient ischemic attacks (TIAs) or minor strokes
• High risk of stroke not manageable by other means

Preparation

• Fasting for at least 8 hours before the procedure
• Medication adjustments as advised by the physician
• Imaging tests like Doppler ultrasound, CT angiography, or MRI to assess the arteries

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made along the neck to access the carotid arteries.
3. Harvesting Vein: A suitable vein, typically from the leg, is harvested for the graft.
4. Grafting: The vein is then used to create a bypass graft from the common carotid artery to the internal carotid artery.
5. Securing Graft: The graft is sutured in place.
6. Closing Incision: The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours.

Setting

Performed in a hospital's surgical suite.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Blood clots
• Re-narrowing of the arteries (restenosis)
• Nerve damage causing voice changes or difficulty swallowing
• Stroke

Benefits

• Improved blood flow to the brain
• Decreased risk of stroke
• Alleviation of symptoms like TIAs

Recovery

• Hospital stay for 1-3 days for monitoring
• Pain management with prescribed medications
• Avoid strenuous activities for 2-4 weeks
• Follow-up appointments for progress assessment and imaging tests

Alternatives

• Carotid endarterectomy: Surgical removal of the blockage within the carotid artery.
• Carotid artery stenting: Insertion of a stent to open the narrowed artery.
• Medication management: Antiplatelet drugs and lifestyle changes.

Patient Experience

Patients will be under general anesthesia during the procedure and will not feel anything. Post-procedure, they may experience some pain and swelling at the incision site, manageable with medication. Hospital staff will ensure comfort and provide detailed instructions for home care.