35656 Bypass graft, with other than vein; femoral-popliteal

Name of the Procedure:

Bypass graft, with other than vein; femoral-popliteal

Summary

A femoral-popliteal bypass graft procedure involves rerouting blood flow around a blocked artery in the leg using a synthetic graft or another type of vessel, other than a vein. This procedure helps improve blood flow to the lower leg and foot.

Purpose

Medical Conditions Addressed:

• Peripheral artery disease (PAD)
• Severe limb ischemia
• Atherosclerosis causing significant artery blockage

Goals/Expected Outcomes:

• Restore adequate blood flow to the lower extremity
• Reduce pain and cramping in the leg
• Prevent limb loss due to severe circulation problems

Indications

Symptoms/Conditions Warranting the Procedure:

• Chronic leg pain or claudication (pain due to inadequate blood flow)
• Non-healing ulcers or sores on the leg or foot
• Gangrene or severe tissue damage due to poor circulation

Patient Criteria:

• Significant artery blockage confirmed by diagnostic imaging
• Inadequate response to less invasive treatments like lifestyle changes or medication

Preparation

Pre-procedure Instructions:

• Fasting for a specified period before the procedure (usually 8-12 hours)
• Adjustments to current medications as advised by the doctor
• Smoking cessation advice

Diagnostic Tests:

• Doppler ultrasound
• Angiography
• Blood tests to assess overall health

Procedure Description

Steps Involved:

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made in the groin and possibly the lower thigh.
3. Graft Placement: A synthetic graft or an alternative vessel is selected and sutured above and below the blockage, creating a new path for blood flow.
4. Closure: The incisions are closed with sutures or staples, and a sterile dressing is applied.

Tools and Equipment:

• Surgical scalpel and sutures
• Synthetic graft materials
• Fluoroscopy or intraoperative ultrasound for guidance

Anesthesia:

• General anesthesia (patient is fully asleep)
• Regional anesthesia (numbness in the lower body)

Duration

The procedure typically takes between 2 to 4 hours.

Setting

Performed in a hospital's operating room.

Personnel

• Cardiovascular surgeon
• Surgical nurses
• Anesthesiologist
• Radiology technician (if imaging is used during surgery)

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Blood clots

Rare Complications:

• Graft failure or blockage
• Heart attack
• Stroke
• Nerve damage

Management:

• Antibiotics for infections
• Anticoagulants to prevent clotting
• Monitoring and supportive care

Benefits

Expected Benefits:

• Improved blood flow to the leg
• Reduction in leg pain and cramping
• Prevention of limb amputation

Realization Time:

• Pain relief may be noticed shortly after recovery
• Full benefits typically realized within weeks to a few months

Recovery

Post-procedure Care:

• Pain management with prescribed medications
• Wound care instructions for incision sites
• Gradual resumption of physical activity

Recovery Time:

• Initial hospital stay of 3-7 days
• Full recovery may take several weeks to a few months

Follow-up:

• Scheduled visits for monitoring graft function and wound healing

Alternatives

Other Treatment Options:

• Angioplasty and stenting
• Endarterectomy (surgical removal of plaque)
• Medications and lifestyle changes

Pros and Cons:

• Angioplasty is less invasive but may not be as effective for severe blockages.
• Medications and lifestyle changes are less invasive but may be insufficient alone for severe cases.

Patient Experience

During Procedure:

• Patient is under anesthesia, will not feel or be aware of the surgery

After Procedure:

• Post-surgical pain and discomfort managed with medication
• Possible feeling of soreness and tightness at incision sites
• Gradual improvement in symptoms as healing progresses

Pain Management:

• Pain relief medications as prescribed
• Cold packs and elevation to reduce swelling and discomfort

Comfort Measures:

• Assistance with mobility during initial recovery
• Use of compression garments if indicated by the healthcare provider