Name of the Procedure:

Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition

Summary

This surgical procedure involves revising a previous bypass surgery in the lower extremity, utilizing a segment of the patient's own vein. It is performed to improve blood flow and resolve complications without the need to remove a blood clot.

Purpose

This procedure is used to address issues in a previously performed arterial bypass in the lower extremity, such as blockages or poor blood flow, by replacing or interposing a segment of vein. The goal is to restore adequate blood flow to the affected limb, alleviate symptoms, and prevent further complications.

Indications

• Persistent or recurring pain in the lower extremity due to inadequate blood flow
• Non-healing ulcers or wounds on the lower extremities
• Previous bypass graft failure
• Critical limb ischemia
• Poor blood flow leading to tissue damage

Preparation

• Fasting for 8-12 hours before the procedure
• Discontinuation of certain medications as advised by the surgeon
• Preoperative imaging tests like Doppler ultrasound or angiography to assess blood vessels
• Blood tests to evaluate overall health and clotting function

Procedure Description

1. The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. An incision is made over the previous surgical site and the existing bypass graft is exposed.
3. A segment of vein, usually harvested from another part of the body, is prepared for interposition.
4. The vein segment is sewn into place, connecting the new bypass route.
5. The surgical site is closed with sutures and a bandage is applied.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Graft failure or blockage
• Nerve injury leading to numbness or weakness
• Blood clots which may cause a stroke or pulmonary embolism
• Anesthesia-related complications

Benefits

• Improved blood flow to the lower extremity
• Relief from pain and symptoms associated with poor circulation
• Increased likelihood of healing for ulcers or wounds
• Prevention of limb loss due to critical ischemia

Recovery

• Hospital stay of 3 to 7 days post-procedure.
• Pain management with prescribed medications.
• Limited physical activity for a few weeks.
• Follow-up appointments for monitoring the graft and overall healing.
• Instructions on wound care and signs of infection to watch for.

Alternatives

• Angioplasty and stenting of the affected artery
• Re-do of the entire bypass graft
• Endovascular procedures
• Medical management with medication and lifestyle changes

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, mild to moderate pain is expected, which can be managed with medications. Patients may experience some swelling and bruising around the surgical site. Full recovery can take several weeks, during which activities may be restricted. Regular follow-up is essential for monitoring progress and addressing any complications promptly.