Name of the Procedure:

Bypass Graft, with Other Than Vein; Axillary-Femoral Common names: Axillary-Femoral Bypass, Axillo-Femoral Bypass

Summary

An axillary-femoral bypass graft is a surgical procedure to create an alternative pathway for blood flow between the axillary artery (located under the collarbone) and the femoral artery (located in the thigh). This is performed using a synthetic graft material to bypass a blocked or narrowed segment of a major artery.

Purpose

The procedure addresses peripheral artery disease (PAD) or other arterial blockages that impede blood flow to the lower extremities. The goal is to restore adequate blood flow to the legs, alleviate symptoms such as pain and cramping, and reduce the risk of limb loss.

Indications

• Severe PAD not amenable to less invasive treatments.
• Critical limb ischemia characterized by severe pain, non-healing wounds, or gangrene in the lower limbs.
• Patients with contraindications to vein grafts or who do not have suitable vein graft material.

Preparation

• Fasting for at least 8 hours before the surgery.
• Medication review and possible adjustments, particularly with blood thinners and antiplatelet medications.
• Preoperative imaging studies like Doppler ultrasound, CT angiography, or MRI to assess the arterial system.

Procedure Description

1. Anesthesia: General or regional anesthesia will be administered.
2. Incisions: Small incisions are made near the axillary artery and femoral artery.
3. Graft Placement: A synthetic graft (often made from Dacron or PTFE) is tunneled under the skin from the axillary artery to the femoral artery.
4. Graft Attachment: The graft is then surgically attached to the arteries, bypassing the blocked or narrowed section.
5. Closure: Incisions are closed with sutures, and dressings are applied.

Duration

The procedure typically takes 2 to 4 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

The surgical team includes:

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Scrub technician

Risks and Complications

• Common: Infection, bleeding, blood clots, graft occlusion.
• Rare: Nerve damage, graft infection, allergic reaction to anesthesia, pulmonary complications.

Benefits

The primary benefit is improved blood flow to the legs, which can relieve pain, facilitate healing of ulcers or wounds, and reduce the risk of amputation. Benefits are often realized within weeks post-surgery.

Recovery

Post-procedure care includes:

• Hospital stay of 3-7 days for monitoring.
• Pain management with medications.
• Instructions on wound care.
• Gradual resumption of activity over several weeks.
• Follow-up appointments for graft surveillance via imaging studies.

Alternatives

• Endovascular procedures such as angioplasty and stenting.
• Other surgical bypass procedures using vein grafts, such as a femoral-popliteal bypass.
• Medication management to improve blood flow and reduce symptoms.

Pros and Cons:

• Endovascular procedures are less invasive with a quicker recovery but might not be suitable for extensive blockages.
• Medication management can be effective for mild symptoms but may not suffice for critical limb ischemia.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel anything. Post-procedure, the patient may experience pain at the incision sites, managed with pain relief medications. Full recovery can take several weeks, with gradual improvement in symptoms and mobility. Post-operative care includes managing discomfort and adhering to follow-up visits for optimal recovery.