35612 Bypass graft, with other than vein; subclavian-subclavian

Name of the Procedure:

Bypass graft, with other than vein; subclavian-subclavian\ Common Name(s): Subclavian-to-subclavian artery bypass, Subclavian artery bypass

Summary

In layman's terms, this procedure involves rerouting blood flow from one subclavian artery to the other using a graft material other than a vein—such as synthetic grafts. This helps ensure that blood reaches necessary areas when one subclavian artery is blocked or narrowed.

Purpose

This procedure addresses occlusion (blockage) or severe narrowing in one of the subclavian arteries, which are vital for supplying blood to the arms and brain. The goal is to restore adequate blood flow and prevent symptoms like arm fatigue, pain, or dizziness.

Indications

• Symptoms such as arm fatigue, pain, or weakness due to reduced blood flow
• Evidence of subclavian artery stenosis or occlusion
• Conditions like subclavian steal syndrome, where blood flow is diverted from the brain to the arm
• Failure of other medical treatments to relieve symptoms

Preparation

• Fasting 6-8 hours before the procedure
• Medication adjustments (e.g., stopping blood thinners)
• Pre-procedure imaging tests like Doppler ultrasound, CT angiography, or MRI to evaluate the arteries

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made above the collarbone to expose both subclavian arteries.
3. A graft material, usually synthetic, is prepared.
4. The graft is anastomosed (connected) end-to-end between the two subclavian arteries, creating a new pathway for blood flow.
5. The incisions are closed with sutures or staples.
6. Once the procedure is completed, blood flow through the new graft is checked to ensure it is adequate.

Duration

Typically, the procedure takes about 2-3 hours.

Setting

The operation is performed in a hospital, specifically in a surgical suite equipped for vascular procedures.

Personnel

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

Risks and Complications

• Common: Bleeding, infection at the incision site, graft occlusion
• Rare: Nerve injury, allergic reactions to anesthesia, stroke
• Management: Close monitoring, antibiotics for infection, and potentially more surgery for complications like graft occlusion

Benefits

• Restoration of adequate blood flow to the affected arm and brain
• Relief from symptoms such as arm pain and dizziness
• Improved quality of life and physical function

Recovery

• Hospital stay for 1-3 days post-procedure
• Pain management with prescribed medication
• Instructions to avoid heavy lifting or strenuous activities for 4-6 weeks
• Follow-up appointments to monitor graft function and overall recovery

Alternatives

• Endovascular procedures like angioplasty and stenting (less invasive but sometimes less durable)
• Conservative management with medication (may not be sufficient for severe blockages)
• Pros of alternatives: Less invasive options have quicker recovery times
• Cons of alternatives: May not be suitable for all cases or offer long-term relief

Patient Experience

• Under general anesthesia, the patient will be asleep and not experience the procedure itself.
• Post-procedure pain mainly at the incision site, managed with pain relief medications
• Temporary restrictions on physical activity to allow proper healing