Bypass graft, with other than vein; aortobi-iliac
CPT4 code
Name of the Procedure:
Bypass Graft, with Other Than Vein; Aortobi-iliac
Common Name(s): Aortobi-iliac bypass, Aortoiliac bypass surgery
Summary
The aortobi-iliac bypass is a surgical procedure aimed at creating a new pathway for blood flow around blocked or narrowed arteries in the aorta (the main artery of the body) and the iliac arteries (major arteries in the pelvis). Instead of using veins, synthetic graft materials are used to redirect blood flow and restore circulation to the lower extremities.
Purpose
This procedure addresses severe blockages or narrowing in the aorta and iliac arteries, often due to atherosclerosis (hardening of the arteries). The goal is to improve blood flow to the legs, reduce symptoms like pain and claudication (pain caused by too little blood flow), and prevent severe complications like gangrene or limb loss.
Indications
- Severe peripheral artery disease (PAD)
- Claudication that limits daily activities
- Rest pain in the lower extremities
- Non-healing ulcers or sores on the legs/feet
- Patients who are not candidates for less invasive procedures
Preparation
- Fasting for at least 8 hours before the procedure.
- Adjustments or discontinuation of certain medications as advised by the doctor.
- Pre-operative imaging studies such as a CT angiogram or MRI to assess the extent of arterial blockage.
- Laboratory tests to evaluate general health and surgical fitness.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the abdomen to access the aorta and iliac arteries.
- The diseased section of the arteries is identified.
- A synthetic graft is sewn onto the aorta above and below the blockage, effectively bypassing the affected area.
- The graft is then connected to the iliac arteries.
- Blood flow is restored through the new pathway, and the incision is closed.
Equipment Used:
- Synthetic graft material
- Surgical instruments for vascular surgery
- Imaging equipment for guidance
Duration
The procedure typically takes 3 to 5 hours.
Setting
Performed in a hospital operating room.
Personnel
- Vascular surgeons
- Anesthesiologists
- Surgical nurses
- Operative technicians
Risks and Complications
Common Risks:
- Infection at the incision site
- Bleeding or hematoma
- Blood clots
Rare Risks:
- Graft thrombosis (clotting of the graft)
- Graft infection
- Injury to surrounding organs or tissues
Benefits
- Restored blood flow to the lower extremities
- Pain relief and improved mobility
- Prevention of severe complications such as limb loss
- Enhanced quality of life
Recovery
- Hospital stay between 5 to 7 days.
- Pain management and wound care instructions.
- Gradual resumption of activities, avoiding heavy lifting for several weeks.
- Follow-up appointments to monitor graft function and overall health.
Alternatives
- Angioplasty and stenting: Less invasive but not suitable for all types of blockages.
- Endarterectomy: Removal of plaque, suitable for localized blockages.
- Medical management with lifestyle changes and medications: Less effective for severe cases.
Patient Experience
Patients typically feel some discomfort after the procedure, managed with pain medications. They may experience fatigue and will need to follow specific care instructions for the surgical site. Most patients report significant improvements in symptoms within a few weeks to months. Regular follow-ups ensure the graft remains functional and complications are promptly managed.