35665 Bypass graft, with other than vein; iliofemoral

Name of the Procedure:

Bypass Graft, with Other than Vein; Iliofemoral

Summary

A bypass graft for iliofemoral arteries is a surgical procedure where a blood vessel other than a vein (typically a synthetic graft) is used to reroute blood flow around a blocked or narrowed artery in the pelvic or upper thigh region.

Purpose

This procedure addresses peripheral artery disease (PAD) affecting the iliac or femoral arteries. It aims to restore adequate blood flow to the leg, alleviate symptoms like pain during walking (claudication), and prevent severe complications such as limb ischemia.

Indications

• Severe leg pain due to PAD
• Non-healing leg wounds associated with poor circulation
• Risk of ischemia leading to possible limb loss
• Decreased blood flow evidenced by diagnostic imaging

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuation of certain medications like blood thinners as advised
• Diagnostic tests such as MRI, CT angiography, or ultrasound to map out the affected arteries

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made over the affected area.
3. A synthetic graft is prepared and positioned as a bypass channel for blood flow.
4. The graft is sewn into place, creating a detour around the blocked artery.
5. The incisions are closed with sutures, and sterile dressings are applied.
   • Techniques utilized include suturing, graft preparation instruments, and imaging support for precise placement.

Duration

Typically takes around 2 to 4 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Vascular Surgeon
• Surgical assistants and nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Graft failure or occlusion
• Blood clots (thrombosis) or embolisms
• Nerve damage or loss of limb sensation

Benefits

• Improved blood flow to the lower extremities
• Relief from pain and discomfort
• Enhanced mobility and quality of life
• Reduced risk of severe complications like limb loss

Recovery

• Hospital stay of several days
• Pain management with medications
• Instructions to avoid strenuous activities for several weeks
• Follow-up appointments for wound inspection and graft assessment

Alternatives

• Medication and lifestyle changes (exercise, diet)
• Endovascular procedures like angioplasty and stenting
• Pros: Less invasive, shorter recovery time
• Cons: Potentially less durable, not suitable for all blockages

Patient Experience

• During: Under anesthesia, so no conscious experience of pain during surgery
• After: Pain or discomfort at the incision site managed by medication, gradual return to normal activities with mobility aids or physical therapy if required.