Name of the Procedure:

Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (e.g., Dacron, ePTFE, bovine pericardium).

Summary

This surgical procedure involves revising a previous arterial bypass in the groin area. It uses a synthetic patch graft, such as Dacron, ePTFE, or bovine pericardium, to restore proper blood flow through the femoral artery.

Purpose

The procedure addresses issues such as blockage, narrowing, or failure of a previous synthetic arterial bypass graft in the groin. The goal is to restore adequate blood flow, prevent limb loss, and alleviate symptoms like pain and tissue damage.

Indications

• Persistent pain in the lower limbs
• Claudication (pain caused by too little blood flow)
• Signs of graft failure or infection
• Non-healing ulcers or tissue loss
• Diagnosed stenosis or blockage in the previous graft

Preparation

• Fast for 8 hours prior to surgery.
• Adjust or temporarily stop certain medications, as advised by your doctor.
• Pre-operative tests like blood work, imaging studies (e.g., angiography or ultrasound), and an overall health assessment.

Procedure Description

1. Administer anesthesia (general or regional).
2. Make an incision in the groin area to access the affected femoral artery and graft.
3. Remove or revise the obstructed section of the original bypass graft.
4. Place the nonautogenous patch graft (e.g., Dacron or ePTFE) to create a new anastomosis (connection) and restore blood flow.
5. Ensure proper blood flow through the new graft with vascular clamps and possibly intraoperative imaging.
6. Close the incision with sutures or staples.
7. Apply a sterile dressing to the surgical site.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

This procedure is performed in a hospital's surgical suite.

Personnel

• Vascular Surgeons
• Surgical Nurses
• Anesthesiologists
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Graft failure or blockage
• Nerve damage
• Reactions to anesthesia
• Long-term risks include graft wear or degradation over time

Benefits

• Restored blood flow to the lower limb
• Relief from pain and claudication
• Prevention of tissue damage and potential limb loss
• Improved quality of life

Recovery

• Hospital stay of several days for monitoring.
• Pain management with prescribed medications.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments to monitor graft function and healing.
• Possible use of compression garments to reduce swelling.

Alternatives

• Endovascular intervention (e.g., angioplasty/stenting) for less invasive treatment.
• Conservative management with medications and lifestyle changes, though less effective for severe cases.
• Autogenous grafts (using the patient's own veins), which may have a lower risk of rejection or infection but are limited by available suitable veins.

Patient Experience

During the procedure, the patient will be under anesthesia and should feel no pain. Post-procedure, there may be soreness, pain at the incision site, and limited mobility. Pain management will be provided to ensure comfort. Full recovery typically spans several weeks, during which patients should follow postoperative care instructions closely. Regular follow-up visits are crucial for optimal recovery and treatment success.