Name of the Procedure:

Creation of Distal Arteriovenous Fistula during Lower Extremity Bypass Surgery (non-hemodialysis)

Summary

The creation of a distal arteriovenous fistula involves connecting an artery and a vein in the lower extremity to improve blood flow, supporting the primary bypass surgery. This helps ensure that the bypass graft stays open and functional.

Purpose

The procedure addresses poor blood flow in the lower extremities, commonly due to peripheral artery disease. The goal is to enhance blood circulation, alleviate symptoms like pain or non-healing wounds, and reduce the risk of limb loss.

Indications

• Severe peripheral artery disease
• Chronic limb ischemia
• Non-healing ulcers or gangrene in the lower extremities
• Symptoms like pain at rest or intermittent claudication
• Failed previous bypass surgeries

Preparation

• Fasting for at least 8 hours before surgery
• Medication adjustments (especially blood thinners)
• Diagnostic tests like Doppler ultrasound or angiography to assess blood vessels

Procedure Description

1. The patient is administered general or regional anesthesia.
2. An incision is made in the lower extremity.
3. The surgeon identifies and prepares the target artery and vein.
4. A side-to-side or end-to-side connection (fistula) is created between the artery and vein.
5. The new arteriovenous fistula is checked for proper blood flow.
6. The incision is closed with sutures or staples.
7. The primary bypass graft is performed in conjunction with the fistula creation.

Tools and Equipment:

• Scalpels, sutures, and surgical clamps
• Microsurgical instruments
• Doppler device to check blood flow

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and the patient’s condition.

Setting

The procedure is performed in a hospital's operating room or a specialized surgical center.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Blood clots
• Damage to nearby nerves or tissues
• Graft occlusion or fistula failure
• Leg swelling

Benefits

• Improved blood flow to the lower extremities
• Alleviation of pain and other symptoms
• Enhanced healing of wounds or ulcers
• Reduced risk of amputation
• Potential for improved mobility and quality of life

Recovery

• Monitoring in a hospital for 1-2 days post-surgery
• Pain management with medications
• Instructions on wound care and keeping the surgical site clean
• Avoiding strenuous activities for 4-6 weeks
• Follow-up appointments to monitor the fistula and bypass graft

Alternatives

• Endovascular procedures like angioplasty and stenting
• Medical management with medications and lifestyle changes
• Amputation in severe, non-repairable cases
• Pros and cons vary: Endovascular procedures are less invasive but might not be as durable; medical management is non-invasive but may not be sufficient in advanced cases.

Patient Experience

During the procedure, the patient will either be under general anesthesia (asleep) or regional anesthesia (numb below the waist). Post-surgery, patients may experience some pain and swelling, managed with medications. Most patients feel an improvement in symptoms within days to weeks.