Name of the Procedure:

Bypass Graft, with Other than Vein; Axillary-Femoral-Femoral Bypass

Summary

In the axillary-femoral-femoral bypass procedure, a surgeon creates a new pathway for blood flow around blocked arteries using a graft. The graft connects an artery under the arm (axillary artery) to arteries in both legs (femoral arteries), helping improve circulation.

Purpose

This procedure is designed to address peripheral arterial disease (PAD), where blood flow to the legs is restricted due to blocked arteries. The goal is to restore normal blood flow, alleviate symptoms like pain and cramping, and prevent complications such as ulcers or gangrene.

Indications

Patients with severe PAD presenting symptoms such as:

• Persistent leg pain (claudication) at rest.
• Non-healing wounds or ulcers on the legs or feet.
• Severe blockages in the leg arteries confirmed via imaging tests.

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Medication adjustments might be necessary, especially blood thinners.
• Pre-operative imaging studies like a CT angiography or magnetic resonance angiography (MRA) to map the arteries.

Procedure Description

1. Anesthesia: Administered either general or regional.
2. Incision: Small incisions made near the collarbone (axillary area) and in each groin (femoral areas).
3. Grafting: A synthetic graft or artery from another body part is placed and sutured to the axillary artery and the femoral arteries.
4. Flow Restoration: The surgeon ensures the graft bypasses the blockage, restoring blood flow to the legs.
5. Closure: Incisions are closed, and sterile dressing is applied.

Duration

The procedure typically takes 3-4 hours.

Setting

Performed in a hospital surgical suite.

Personnel

• Vascular Surgeon
• Surgical Nurses
• Anesthesiologist
• Operating Room Technicians

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Graft occlusion or failure.
• Reaction to anesthesia.
• Rarely, nerve injury or limb loss.

Benefits

• Improved blood flow to the legs.
• Relief from pain and cramping.
• Enhanced healing of leg ulcers.
• Prevention of severe complications like gangrene.

Recovery

• Hospital stay of 3-7 days post-procedure.
• Pain management with prescribed medications.
• Gradual return to activities over 4-6 weeks.
• Follow-up appointments to monitor graft function and healing.

Alternatives

• Angioplasty and stenting: Less invasive but may not be suitable for all patients.
• Conservative management: Includes medication and lifestyle changes but may not resolve severe blockages.
• Other types of surgical bypass: Different routes might be used depending on the blockage locations.

Patient Experience

During the procedure, the patient will be under general or regional anesthesia, ensuring they experience no pain. Post-operatively, they might feel soreness at the incision sites and some discomfort in the legs as they heal. Pain management strategies and support from the healthcare team help ensure comfort and a smooth recovery.