Name of the Procedure:

Bypass graft, with other than vein; subclavian-axillary
Common name(s): Subclavian-axillary artery bypass graft

Summary

A subclavian-axillary bypass graft is a surgical procedure that involves redirecting blood flow around a blocked or narrowed segment of the subclavian or axillary artery. Unlike traditional grafts that use veins, this procedure uses synthetic materials or arteries from another part of the body.

Purpose

This procedure addresses blockages or narrowing of the subclavian or axillary artery that can impede blood flow to the arms and brain. The goal is to restore adequate blood circulation, alleviate symptoms, and prevent complications like stroke or arm ischemia (inadequate blood supply to the arms).

Indications

• Severe stenosis (narrowing) or occlusion (blockage) of the subclavian or axillary artery
• Symptoms of arm ischemia, such as pain, numbness, or weakness
• Subclavian steal syndrome, where blood flow is redirected from the brain to the arm, causing dizziness or neurological symptoms
• Failure of less invasive treatments or progression of arterial disease

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Adjustments to current medications, as advised by the physician.
• Pre-operative diagnostic tests, such as Doppler ultrasound, CT angiography, or MRI, to assess the arterial blockage and plan the surgery.
• Pre-surgical assessments including blood tests, ECG, and chest X-ray.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made near the collarbone or in the upper chest to access the subclavian and axillary arteries.
3. The surgeon harvests a suitable artery from another part of the body or uses a synthetic graft.
4. The graft is sutured to the subclavian artery above the blockage and the axillary artery below the blockage to bypass the obstructed segment.
5. Incisions are closed, and sterile dressings are applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and individual patient factors.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Post-operative care team

Risks and Complications

Common risks include bleeding, infection, and blood clots. Rare complications could involve graft failure, nerve damage, or adverse reactions to anesthesia. Proper management protocols will be in place to address any complications.

Benefits

Successful grafting restores proper blood flow, alleviates symptoms, and reduces the risk of serious complications like stroke or limb ischemia. Improvement in symptoms is generally noticeable shortly after recovery.

Recovery

Post-procedure, the patient may be monitored in the intensive care unit (ICU) for a day or two before being moved to a regular hospital room. Pain management, wound care, and instructions on activity restrictions will be provided. Recovery can take several weeks to months, and follow-up appointments will monitor the graft's success.

Alternatives

• Endovascular procedures, such as angioplasty and stenting
• Medical management with antiplatelet drugs and vasodilators
• Conservative treatment with lifestyle modifications The choice of alternatives depends on the severity of the condition and overall health of the patient.

Patient Experience

During the procedure, the patient will be under general anesthesia and won’t feel any pain. Post-operative discomfort and pain will be managed with medications. Patients may experience soreness around the incision site and temporary restrictions on physical activities.

Continuous support and information will be provided to ensure a comfortable recovery.