Bypass graft, with vein; axillary-femoral-femoral
CPT4 code
Name of the Procedure:
Bypass Graft, with Vein; Axillary-Femoral-Femoral
Common names: Axillo-Femoral Bypass, Ax-Fem Bypass
Medical term: Axillofemoral-Femoral Bypass Graft using Vein
Summary
An axillary-femoral-femoral bypass graft is a surgical procedure that creates a new route for blood flow using a vein graft, bypassing blocked arteries between the shoulder and legs.
Purpose
This procedure is performed to treat severe arterial blockages that impede blood flow to the legs. The expected outcome is improved blood flow and relief from symptoms such as pain and tissue damage.
Indications
Indicated for patients with peripheral artery disease (PAD), especially those with critical limb ischemia or unsuitable for more conventional arterial reconstruction methods.
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Adjustments to medications, particularly blood thinners, may be necessary.
- Pre-operative tests include blood work, imaging studies (like an angiogram), and a physical exam to assess cardiovascular status.
Procedure Description
- The patient is placed under general anesthesia or regional anesthesia with sedation.
- A vein is harvested, often from the leg, to use as the graft.
- An incision is made near the armpit (axillary area) and two more near the groin (femoral area).
- The harvested vein is connected (anastomosed) to the axillary artery and then to each femoral artery, creating a new pathway for blood flow.
- The incisions are closed with sutures or staples, and dressings are applied.
Duration
The procedure typically takes around 3-4 hours.
Setting
Performed in a hospital operating room.
Personnel
- Vascular surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technologist
Risks and Complications
- Infection at the incision site
- Bleeding or blood clots
- Graft occlusion or failure
- Injury to surrounding blood vessels or nerves
- Reactions to anesthesia
Benefits
- Improved blood flow to the lower extremities
- Relief from pain and symptoms associated with blocked arteries
- Potential to save limbs from amputation
Recovery
- Hospital stay of 3-7 days post-procedure
- Instructions for wound care and activity limitations
- Follow-up appointments for monitoring graft function
- Full recovery may take several weeks; walking may be limited initially
Alternatives
- Angioplasty with or without stenting
- Femoropopliteal bypass
- Medical management including lifestyle changes and medications
- Endovascular procedures
Patient Experience
- Patients may feel sore and tired post-surgery.
- Pain management typically includes oral pain relievers.
- Discomfort at incision sites; managed with prescribed medications.
- Encouraged to gradually increase physical activity as advised by healthcare providers.