Bypass graft, with vein; axillary-brachial
CPT4 code
Name of the Procedure:
Bypass Graft, with Vein; Axillary-Brachial
Common Name: Arm Vein Bypass
Technical Term: Axillary-Brachial Vein Bypass Graft
Summary
An axillary-brachial vein bypass graft is a surgical procedure to restore blood flow in the upper arm by diverting blood around a blocked or narrowed artery using a section of a vein from the patient's own body.
Purpose
This procedure addresses severe blockages or narrowing of the arteries in the upper arm. The goal is to improve blood circulation and relieve symptoms like pain, numbness, or weakness, thereby preventing further tissue damage.
Indications
- Severe atherosclerosis or artery blockages in the upper arm.
- Symptoms like pain, numbness, or weakness in the arm.
- Risk of tissue damage due to poor blood flow.
Preparation
- Patients may be instructed to fast for 8-12 hours before the surgery.
- Certain medications may need to be stopped or adjusted.
- Pre-operative tests such as blood work, imaging studies, and cardiovascular assessments might be required.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: An incision is made near the armpit (axillary area) and another near the upper arm (brachial area).
- Vein Harvesting: A suitable vein, often from the leg, is harvested.
- Bypass Creation: The harvested vein is grafted to bypass the blocked segment of the artery, connecting from the axillary artery to the brachial artery.
- Closure: Incisions are closed with sutures, and sterile dressings are applied.
The procedure uses surgical instruments such as scalpels, forceps, vein strippers, and staple or suture equipment.
Duration
The procedure typically takes 3 to 4 hours.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Vascular surgeon
- Surgical nurses
- Anesthesiologist
- Surgical assistants and possibly a perfusionist
Risks and Complications
- Infection at the incision sites
- Bleeding or blood clots
- Vein graft occlusion (blockage)
- Nerve damage
- Anesthesia-related complications
Benefits
- Improved blood circulation in the arm.
- Relief from pain and numbness.
- Prevention of further tissue damage. Results can often be noticed soon after recovery from the surgery.
Recovery
- Patients typically stay in the hospital for 1-3 days.
- Instructions include wound care, activity restrictions, and medication guidelines.
- Full recovery may take several weeks to a few months.
- Follow-up appointments to monitor graft function and overall recovery.
Alternatives
- Medication management to improve circulation.
- Angioplasty with or without stenting.
- Exercise therapy or lifestyle changes.
- Pros and cons include less invasiveness but possibly lower efficacy compared to surgery.
Patient Experience
Patients may experience pain and discomfort, primarily managed with pain medications and proper care. Post-operative physical sensations can include swelling, bruising, and temporary limited mobility in the affected arm.
Pain management includes prescribed analgesics and comfort measures like rest and elevation of the arm.