35626 Bypass graft, with other than vein; aortosubclavian, aortoinnominate, or aortocarotid

Name of the Procedure:

Bypass Graft, with Other Than Vein; Aortosubclavian, Aortoinnominate, or Aortocarotid

Summary

A surgical procedure that involves creating a bypass around a blocked or narrowed artery near the aorta to restore proper blood flow to the subclavian, innominate, or carotid arteries using a graft other than a vein, typically an artificial graft.

Purpose

The procedure aims to treat blockages or narrowing (stenosis) in the arteries that stem from the aorta, such as the subclavian, innominate, or carotid arteries. The primary goal is to restore adequate blood flow, reduce the risk of stroke or other complications, and alleviate symptoms like dizziness, arm weakness, or severe headaches.

Indications

• Severe atherosclerosis causing significant artery narrowing.
• Symptoms of decreased blood flow (e.g., arm claudication, dizziness, stroke-like symptoms).
• Failure of less invasive treatments (e.g., medication or angioplasty).
• Presence of an aneurysm in the affected artery.

Preparation

• Fasting for at least 8 hours before surgery.
• Discontinuation or adjustment of certain medications, especially blood thinners, as advised by the doctor.
• Pre-operative diagnostic tests, including blood work, imaging studies like CT or MRI scans, and sometimes angiography.

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical incision is made along the chest or neck, depending on the targeted arteries.
3. The section of artery to be bypassed is isolated.
4. A graft (usually made of synthetic material) is sewn into place to create a new pathway for blood flow, bypassing the blocked segment.
5. The incision is closed with sutures, and a drainage tube may be placed to remove excess fluids.
6. The patient is moved to the recovery area for monitoring.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon(s)
• Surgical assistants
• Nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Blood clots or embolism
• Graft occlusion or failure
• Adverse reactions to anesthesia
• Stroke or heart attack
• Nerve damage with potential weakness or numbness

Benefits

• Improved blood flow to the affected areas.
• Reduction or elimination of symptoms like dizziness and arm weakness.
• Lowered risk of stroke and other complications from inadequate blood supply.

Recovery

• Post-procedure hospital stay of 3 to 7 days for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for monitoring the graft's function and healing progress.
• Gradual resumption of normal activities within 4 to 6 weeks, with full recovery possibly taking several months.

Alternatives

• Balloon angioplasty with or without stenting
• Medical management with drugs to control symptoms and risk factors
• Endarterectomy (removal of plaque from the artery)
• Each alternative has its own risks and benefits, which need to be discussed with a healthcare provider to determine the best course of action for the patient's specific condition.

Patient Experience

Patients might feel groggy and sore post-procedure, especially at the incision site. Pain is usually managed with medications. Gradual improvement in symptoms like dizziness and arm weakness is expected within days to weeks after surgery. Adherence to post-operative care and restrictions is crucial for a smooth recovery, and support from healthcare providers will be available to manage any discomfort.