35525 Bypass graft, with vein; brachial-brachial

Name of the Procedure:

Bypass Graft with Vein; Brachial-Brachial

• Common Name: Brachial-Brachial Vein Bypass
• Technical Term: Brachial Artery-to-Brachial Artery Bypass Grafting

Summary

A Brachial-Brachial Vein Bypass is a surgical procedure where a section of vein is used to create a new pathway for blood flow between two segments of the brachial artery in the arm. This allows blood to bypass a blocked or narrowed portion of the artery.

Purpose

• Medical Condition: This procedure addresses severe blockages or narrowing (stenosis) in the brachial artery, which can impact blood flow to the forearm and hand.
• Goals: To restore adequate blood circulation, alleviate symptoms such as pain or numbness, and prevent potential tissue damage or loss.

Indications

• Symptoms such as severe arm pain, numbness, or weakness.
• Critical limb ischemia (very poor blood flow to the arm/hand).
• Evidence of arterial insufficiency not responsive to less invasive treatments.

Preparation

• Pre-Procedure Instructions: Patients may be advised to fast for a specific period before surgery. Any regular medication adjustments will be coordinated by healthcare providers.
• Diagnostic Tests: Ultrasound, angiography, or MRI to visualize the blood vessels and identify the blockage.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made to access the brachial artery above and below the blockage.
3. Vein Harvesting: A suitable vein, often from the patient's leg, is harvested.
4. Bypass Creation: The harvested vein is attached (anastomosed) to the brachial artery above and below the blockage, effectively creating a new route for blood flow.
5. Closure: Incisions are closed with sutures or staples, and sterile dressings are applied.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Primary Surgeon: A vascular or cardiovascular surgeon.
• Assisting Surgeon: May assist with the procedure.
• Nurses: Provide intraoperative support.
• Anesthesiologist: Manages anesthesia and patient monitoring.

Risks and Complications

• Common Risks: Infection, bleeding, and swelling at the incision site.
• Rare Risks: Blood clots, graft failure, nerve injury, or adverse reactions to anesthesia. Complications may require additional interventions.

Benefits

Restored blood flow to the arm, relief from ischemic symptoms (pain and numbness), and preservation of arm function. Positive outcomes can often be observed soon after surgery.

Recovery

• Post-Procedure Care: Pain management, antibiotics to prevent infection, and monitoring for potential complications.
• Recovery Time: Generally, 2 to 6 weeks with gradual return to normal activities.
• Restrictions: Avoid heavy lifting and strenuous activities for several weeks.
• Follow-Up: Regular check-ups to monitor the graft and overall vascular health.

Alternatives

• Angioplasty and Stenting: Less invasive but may be less effective for severe blockages.
• Medication Management: To improve symptoms, but may not resolve severe blockages.
• Pros/Cons: Less invasive options may have fewer immediate risks but might not be as effective in restoring proper blood flow compared to surgical bypass.

Patient Experience

• During Procedure: Under general anesthesia, the patient will be unconscious and feel no pain.
• After Procedure: Some pain and discomfort at incision sites, managed with prescribed pain relief.
• Pain Management: Pain typically decreases after a few days, with medications and care to ensure comfort.