Bypass graft, with other than vein; axillary-popliteal or -tibial
CPT4 code
Name of the Procedure:
Bypass Graft, with Other than Vein; Axillary-Popliteal or -Tibial
Summary
A bypass graft, with other than vein, involves using a synthetic tube or artery from another part of the body to create a new route for blood flow around a blocked artery. It is performed between the axillary (armpit) and popliteal (knee) or tibial (lower leg) arteries to restore adequate blood circulation to the lower extremities.
Purpose
This procedure addresses severe blockages in the arteries that supply blood to the legs, which can result in pain, difficulty walking, or non-healing wounds. The goal is to improve blood flow, relieve symptoms, and prevent complications such as tissue death or amputation.
Indications
- Severe peripheral artery disease (PAD)
- Claudication (pain while walking)
- Non-healing ulcers or sores on the legs
- Rest pain (pain at rest due to poor circulation)
- Risk of tissue loss or gangrene
Preparation
- Fasting for several hours prior to surgery.
- Adjustments to medications, including blood thinners or diabetes medications.
- Pre-operative assessments, including blood tests, electrocardiogram (ECG), and imaging studies like a Doppler ultrasound or angiography.
- Consultation with the surgical team and anesthesiologist.
Procedure Description
- The patient receives either general or regional anesthesia.
- The surgeon makes an incision near the axillary artery.
- Another incision is made at the point of the lower block, either near the popliteal or tibial artery.
- A synthetic graft or another artery is harvested or prepared.
- The graft is sewn into place, creating a new pathway for blood flow.
- Incisions are closed, and the surgical area is cleaned and bandaged.
Specialized tools include scalpels, sutures, synthetic grafts or harvested arteries, and advanced imaging technology for precision.
Duration
The procedure typically takes between 3 to 5 hours.
Setting
This procedure is usually performed in a hospital's surgical suite.
Personnel
- Vascular surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection at the incision site
- Bleeding or hematoma formation
- Blood clots within the graft
- Graft failure or occlusion
- Complications from anesthesia
- Nerve or tissue damage
Benefits
- Improved blood flow to the lower extremities
- Relief from pain and symptoms associated with PAD
- Enhanced ability to walk and perform daily activities
- Reduced risk of ulcers, gangrene, and amputation
Recovery
- Hospital stay of several days post-procedure.
- Instructions on wound care, activity restrictions, and medication usage.
- Gradual resumption of physical activity, with follow-up appointments for monitoring progress.
- Possible physical therapy to aid in recovery.
Alternatives
- Angioplasty with or without stenting
- Endarterectomy (removal of plaque from arteries)
- Conservative management with medications and lifestyle changes
Each alternative has its pros and cons; angioplasty may have a shorter recovery time, while medications might be less invasive but offer slower improvement.
Patient Experience
Patients will be under anesthesia during the procedure, ensuring they feel no pain at that time. Post-operatively, they might experience discomfort or pain managed through prescribed pain relief. Initial mobility restrictions are expected, with gradual improvement as healing progresses. Regular follow-up helps ensure optimal recovery and graft function.