Definition of aortic artery bypass surgery
Artificial tubes (grafts) are placed near a section of a blocked or narrowed blood vessel. They create a path so blood can move around the blockage. In this case, the grafts are placed over the course of the aorta, iliac artery, or groin.
The aorta is the main artery leaving the heart. It brings oxygen-rich blood to the body. At about the level of the umbilicus, the aorta divides into two iliac arteries. At the level of the thigh, the iliac arteries become the femoral arteries.
Aortic bypass surgery with the thighs is also called aortic bypass. That's because it's an inverted 'y' shaped.
Most bypass surgeries involve a traditional open incision. Research is being done on how to perform these operations through laparoscopic or mini-laparotomy techniques. Where much smaller incisions are used.
Reasons for performing aortic bypass surgery
For good blood flow to the lower body, there must be good blood flow through the aorta, iliac arteries, and femoral arteries. Atherosclerosis is a disease in which sticky patches (plaques) build up along the walls of blood vessels. These plaques prevent the normal flow of blood within the affected blood vessels. When blood flow is reduced, the tissues on the other side of the blockage do not receive enough oxygen. This can lead to the following:
- Pain that increases the longer you walk or exercise (called intermittent claudication)
- cold feet or legs
- flaking, dryness, redness, itching, brown skin on the legs or feet
- Non-healing and/or infected sores on your legs or feet
- Leg amputation required
- nerve damage
Aortic bypass surgery can restore blood flow to the legs
Possible complications of aortic bypass surgery
Problems from this procedure are rare, but all procedures involve some risks. Your doctor will review potential problems, such as:
- The new bypass is blocked by blood clots
- Anesthesia complications
- nerve damage
Before the procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Chronic diseases such as diabetes or obesity
Types of aortic bypass surgery
Femoral arteriovenous bypass surgery is the best option for a blockage that restricts blood flow to the femoral artery. However, there is another procedure called axillary bypass that can be used in some cases heart bypass surgery.
Femoral axillary bypass puts less pressure on the heart during cardiothoracic surgery. It also does not require opening your abdomen during aortic bypass surgery. This is because it uses a plastic tube graft called an aortic bypass graft and connects the femoral arteries in your legs to the axillary artery in your shoulder. However, the surgery used for this procedure has a higher risk of blockage, infection and other complications because it travels a greater distance and because the axillary artery is not the size of the aorta. The increased risk of complications is because the graft is not buried deeply in the tissue and because the bypass is narrower in this procedure.
What to expect when arranging for aortic bypass surgery
before the procedure
Your doctor may:
- Clinical examination
- Blood tests
- Ankle and upper arm index - This test compares blood pressure measurements in your arms and legs. These numbers should be very similar. If the values in your legs are much lower than those in your arms, this indicates a blockage in the arteries that carry blood through your legs.
- Doppler ultrasound - This test uses sound waves to check blood flow in the arteries. It can identify blocked arteries.
- Angiography - a dye is injected into your arteries and x-rays are taken of your legs. Since the dye will not be able to flow through areas that are narrow or clogged by plaques, the exact location of the blockages will be located. Other types of minimally invasive angiography currently in use also include CT angiography and magnetic resonance angiography.
Before having aortic artery bypass surgery:
- Don't eat or drink anything after midnight the night before bypass surgery.
- Arrange for help at home after you return from the hospital.
- Arrange to have someone drive you home when you leave the hospital.
Talk to your doctor about your medications. You may be asked to stop taking certain medications for up to a week before the procedure.
Description of the aortic bypass surgery procedure
A large incision will be made in your abdomen. The muscles around your abdomen will be cut. To access the abdominal aorta, some organs must be carefully moved out of the way.
The blood flow through the vessels will be stopped for a short time. Clips will be placed on either side of the blocked area to stop the blood flow. The bypass will be sewn in place. The coronary artery bypass will be done by attaching one end of it to the aorta, which is just above the blockage. And ligation of the other end immediately after the blockage on the femoral or iliac arteries.
The clamps will be removed. The doctor will monitor to make sure there is good blood flow through the bypass. Your internal organs will go back into place. The abdominal muscles will be tightened together. The muscles will be sutured closed. The skin incision will be closed with either sutures or staples.
After aortic artery bypass surgery
After surgery, you will be taken to a recovery room. The tube in your throat may be removed, or it may need to be in it for a few days. Epidural anesthesia may also last for a few days. You will be monitored for any adverse reactions to surgery or anesthesia.
How much will it hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the operation can be controlled with medication.
Average hospital stay
The usual length of stay is 5-7 days. The length will depend on your general health and the speed of your recovery. Your doctor may choose to keep you for longer if complications arise.
Post-aortic bypass care
in the hospital
You will need to spend a day or two in bed after the procedure.
- You will be carefully monitored in the intensive care unit (ICU). You may be there for a day or two as needed.
- An incentive spirometer, to be used every 2 hours during the day. This will keep your lungs as open as possible and help avoid pneumonia.
- A nasogastric (NG) tube may be placed during the procedure. The tube is placed up your nose and into your stomach. Your bowel often stops working normally after surgery. You won't be able to take anything by mouth until it starts working again. The NG tube will then be removed. You will slowly progress from a liquid diet, to a soft food diet, and finally to a regular diet.
- You may also be given daily medication to help avoid blood clots.
During your stay, the cardiac surgery department hospital staff will take steps to reduce the chance of infection, such as:
- wash their hands
- Wearing gloves or masks
- Keep surgical wounds covered with a bandage
There are also steps you can take to reduce your chances of infection, such as:
- Wash your hands frequently and remind visitors and health care providers to do the same
- Remind healthcare providers to wear gloves or masks
- Do not allow others to touch the wound
Recovery may take up to 6 weeks. Expect to see a significant improvement in your general ability to walk or exercise. When you go home, you'll need to keep the wound clean to prevent infection. Pain can be controlled with medication. You may be referred to a physical therapist to maintain or rebuild your strength.
Eighty percent of aortofemoral bypass surgeries successfully open the artery and relieve symptoms for 10 years after the procedure. Your pain should ease when you are resting. The pain should also disappear or significantly reduce when walking. You will have better prognosis if you do not smoke or quit before aortic bypass surgery.
Contact your doctor after aortic artery bypass surgery
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, contact your doctor:
- Signs of infection including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the wound site
- Constant nausea or vomiting
- Pain that you cannot control with the medicines you have been given
- Pain, burning, urgency, frequent urination, or persistent bleeding in the urine
- Cough, shortness of breath, or chest pain
- Your leg becomes cold, pale, blue, tingly, or numb
- Pain or swelling in your legs, calves, or feet
If you think you have an emergency, call emergency medical services immediately
The most frequently asked questions about aortic bypass surgery in Turkey
What is the anesthesia used in aortic artery bypass surgery?
- General anesthesia is used for this surgery. You will be asleep.
- Epidural anesthesia may be added. Your body will be numb from the chest down.
How long will it take to have an aortic bypass surgery?
about 3-4 hours