35540 Bypass graft, with vein; aortobifemoral

Name of the Procedure:

Bypass Graft, with Vein; Aortobifemoral Common name(s): Aortobifemoral bypass, Aortobifemoral graft, AFB graft

Summary

An aortobifemoral bypass graft is a surgical procedure where a vein from the patient's own body, often the saphenous vein, is used to create a new pathway for blood flow around blocked or narrowed sections of the aorta and the femoral arteries in both legs. This helps restore proper circulation.

Purpose

The procedure is designed to treat severe blockage or narrowing of the aorta and the femoral arteries, often caused by peripheral artery disease (PAD) or atherosclerosis. The goal is to alleviate symptoms like leg pain, improve walking ability, and prevent serious complications like gangrene or limb loss.

Indications

• Symptoms such as severe leg pain, cramping, or fatigue when walking.
• Non-healing wounds or ulcers on the legs or feet.
• Severe narrowing or blockage in the aorta or femoral arteries.
• Ineffectiveness of non-surgical treatments or lifestyle changes.

Preparation

• Patients may be instructed to fast for at least 8 hours before the procedure.
• Pre-operative tests such as blood work, electrocardiogram (EKG), and imaging studies (e.g., CT scan, angiography) are typically conducted.
• Patients should discuss all current medications with their doctor, as some may need to be adjusted.

Procedure Description

1. The patient is administered general anesthesia.
2. The surgeon makes an incision in the abdomen to access the aorta.
3. A second incision is made in each groin to access the femoral arteries.
4. A vein (usually the saphenous vein) is harvested and used to create a bypass graft connecting the aorta to the femoral arteries, bypassing the blocked sections.
5. The grafted vein is sutured in place, and the incisions are closed.

Duration

The procedure typically takes about 3 to 6 hours, depending on the complexity.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Blood clots

Rare risks:

• Graft failure
• Heart attack or stroke
• Nerve damage

Management of complications may involve medications, additional surgical or medical interventions, and close monitoring.

Benefits

• Improved blood flow to the legs.
• Reduced leg pain and cramping.
• Enhanced ability to walk and perform daily activities.
• Lower risk of severe complications like limb loss.

The benefits can often be realized within a few weeks post-surgery.

Recovery

• Patients typically stay in the hospital for about a week.
• Initial rest and gradual increase in activity as guided by the healthcare team.
• Incision care and monitoring for signs of infection.
• Follow-up appointments to check on the graft and overall recovery.
• Temporary dietary and activity restrictions may apply.

Alternatives

• Angioplasty and stenting
• Endarterectomy (removal of plaque from the artery)
• Medical management and lifestyle changes

Each alternative has its pros and cons, such as varying degrees of invasiveness, effectiveness, recovery times, and suitability for different patient conditions.

Patient Experience

During the procedure, the patient will be under general anesthesia and will feel no pain. Post-surgery, some discomfort, pain, and fatigue are normal. Pain will be managed with medication, and the healthcare team will provide measures to ensure comfort and promote healing.