Arterial Bypass and Endovascular Treatment
What is an arterial bypass?
An arterial bypass is a surgical procedure that involves creating a new pathway to reroute blood flow around a blocked blood vessel or artery with the use of a graft. This procedure is recommended if:
- The arteries are too narrowed or blocked due to the presence of plaque inside the artery walls.
- The patient may be living with more than one diseased artery on different levels of the anatomy.
- The patient has extensive disease leading to gangrene.
When the arteries are blocked, blood cannot pass through the arteries to nourish the tissues, which may then lead to cramping in muscles (claudication) of the lower extremities and under the worst situation dead tissue also called gangrene.
What are the symptoms of a blocked or narrowed artery?
Signs and symptoms of a blocked or narrowed artery include:
- Claudication – These are cramps that affect the lower limbs associated with walking or exercise. The pain is usually relieved by reducing the pace or resting. As soon as the activity restarts the cramps or pain returns.
- Burning feet
- Blue or white discolouration when walking or elevation of the feet.
- Blue painful toes.
- Non-healing ulcers – These are ulcers that are resistant to healing with standard dressings.
- Ischemic ulcers – round extremely painful punched-out ulcers on the feet.
What does arterial bypass involve?
Arterial bypass surgery varies depending on the patient’s condition and will require a hospital stay. During the procedure, the patient will be required to first empty the bladder, and an intravenous (IV) line will be inserted in the hand or arm. Other catheters may also be placed in the neck and wrist to monitor the heart and blood pressure. A ventilation tube will be inserted in the throat, which will help with breathing during the procedure.
An incision will then be made in the affected limb. The incision depends on where the artery is blocked. If the aorta or Iliac arteries are blocked, it may be necessary to do a laparotomy. A vein from the same or the opposite leg may be used and implanted in the affected leg. If there is no suitable vein, a synthetic artery will be used for the bypass. The arterial bypass graft will be sutured with specialized needles and sutures to the artery above and below the occluded segment. After the bypass has been completed, a drain is inserted to drain any blood or clear fluid from the wound. The incision is then closed with absorbable sutures, and a dressing is applied. Patients will be placed in a High Care or Intensive Care Unit for the first 24 hours. This step is essential to reduce and identify any medical issues or early complications and deal with them effectively. A physiotherapist will also attend to the patient to help with recovery and rehabilitation.
