Name of the Procedure:

In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery

Summary

In-situ vein bypass surgery involves using a vein from the patient's own body to bypass a blocked or narrowed artery in the leg. The procedure helps restore blood flow to areas affected by poor circulation.

Purpose

The main goal of this procedure is to treat peripheral artery disease (PAD), which occurs when arteries in the legs are narrowed or blocked by plaque buildup. Restoring blood flow can alleviate symptoms such as leg pain and prevent serious complications like tissue damage or amputation.

Indications

• Chronic leg pain while walking or at rest due to PAD.
• Non-healing wounds or ulcers on the legs or feet.
• Gangrene or severe tissue damage stemming from poor circulation.
• Patients with suitable vein anatomy for the bypass.

Preparation

• Patients may need to fast for 8-12 hours before the surgery.
• Blood tests, imaging studies (like duplex ultrasound or angiography), and cardiovascular assessments are conducted.
• Medications may need adjustment, particularly blood thinners or anticoagulants.
• Patients are typically advised to stop smoking and control other risk factors like diabetes.

Procedure Description

1. Anesthesia: The procedure is performed under general or regional anesthesia.
2. Incision: An incision is made over the target artery and the vein to be used.
3. Vein Preparation: The chosen vein, usually the saphenous vein, is identified and left in its original position (in-situ).
4. Valves Removal: Small incisions are made to remove or bypass valves within the vein to ensure proper blood flow direction.
5. Attachment: One end of the vein is connected to the artery above the blockage, and the other end to the artery below the blockage.
6. Closure: Incisions are closed, and sterile dressings are applied.

Duration

The procedure typically takes 3-5 hours, depending on the complexity and the patient's condition.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Scrub Technicians
• Post-operative Care Team

Risks and Complications

• Infection and bleeding
• Blood clots
• Vein graft failure or blockage
• Nerve damage
• Anesthesia-related complications
• Rarely, heart attack or stroke

Benefits

• Improved blood flow to the lower extremities
• Relief from leg pain and cramps
• Healing of leg ulcers and prevention of gangrene
• Reduced risk of amputation

Expected benefits may be realized within a few weeks as blood flow improves.

Recovery

• Patients typically stay in the hospital for 3-7 days.
• Walking and physical therapy are encouraged as tolerated.
• Avoidance of heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and graft function.

Alternatives

• Angioplasty and Stenting: Less invasive, but may not be as effective for severe blockages.
• Medical Management: Medications and lifestyle changes to manage PAD.
• Amputation: In severe cases where limb salvage is not possible.

Patient Experience

Patients may experience some pain and discomfort initially, managed with medications. Expect some bruising and swelling at the incision sites. Walking may be encouraged soon after surgery to stimulate blood flow, but activity will be gradually increased as recovery progresses. Regular follow-up appointments will monitor graft function and overall recovery.