Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

In a bypass, artificial tubes (grafts) are placed near a section of the blood vessel that is blocked or narrowed. The graft creates a path so that blood can move around the blockage. In this case, the grafts are placed on the aorta and the iliac or femoral arteries.

The aorta is the major artery that leaves the heart. It brings oxygen-rich blood to the body. At about the level of the belly button, the aorta divides into two iliac arteries. At the level of the groin, the iliac arteries become the femoral arteries.

Aortofemoral bypass is also called aorto bi femoral bypass. This is because the graft is formed in the shape of an upside down "y."

Most bypass surgery involves a traditional, open incision. Research is being done on how to do these operations through laparoscopic or mini-laparotomy techniques. They use much smaller incisions.

Aortofemoral Bypass Graft

Aorta Femoral Bypass
Artificial grafts create a path so that blood can move around the blockage.
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Reasons for Procedure

To have good blood flow to the lower part of the body, there must be good blood flow through the aorta, the iliac arteries, and the femoral arteries. Atherosclerosis is a disease in which sticky patches (plaques) build up along the walls of blood vessels. These plaques block the normal flow of blood within affected blood vessels. When the blood flow is decreased, the tissues on the other side of the blockage do not receive enough oxygen. This can result in the following:

  • Pain that increases the longer you walk or exercise (called intermittent claudication)
  • Cold feet or legs
  • Scaly, dry, reddened, itchy, or brown skin on the legs or feet
  • Nonhealing and/or infected sores (ulcers) on your legs or feet
  • Gangrene
  • The need for amputation of the leg
  • Nerve damage

This surgery can restore blood flow to the legs.

Possible Complications

If you are planning to have a bypass, your doctor will review a list of possible complications, which may include:

  • Infection
  • Obstruction of the new graft by blood clots
  • Bleeding
  • Complications from anesthesia
  • Scarring
  • Nerve damage

Factors that may increase the risk of complications include:

What to Expect

Your doctor may do the following:

Leading up to your procedure:

  • Do not eat or drink anything after midnight the night before your 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 medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

General anesthesia is used for this surgery. You will be asleep. A tube will be inserted into your throat to help you breathe.

Sometimes, an epidural anesthesia will be added. This anesthesia is injected into the spinal column. It will numb your body from the chest down.

A large incision will be made in your abdomen. The muscles around your abdomen will be cut. To get to the blood vessels, some organs will need to be carefully moved out of the way.

Blood flow through the vessels will be briefly stopped. Clamps will be placed on either side of the blocked area to stop blood flow. The graft will be sewn into place. One end of the graft will be attached to the aorta just above the blockage. The other end will be attached just after the blockage on the femoral or iliac arteries.

The clamps will be removed. The doctor will watch to make sure there is good blood flow through the graft. Your internal organs will be put back into place. The abdominal muscles will be pulled together. The muscles will be stitched closed. The skin incision will be closed with either sutures or staples.

After the surgery, you will be brought to a recovery room. The tube in your throat may be removed, or it may need to stay in for a few days. The epidural anesthesia may also be continued for a few days. You will be monitored for any adverse reactions to the surgery or anesthesia.

About 3-4 hours

Anesthesia will block pain during the surgery. The large incision will cause pain after the surgery. You will be given pain medicine to help manage pain.

The usual length of stay is 5-7 days. The length will depend on your overall health and the speed of your recovery. Your doctor may choose to keep you longer if complications arise.

You will need to spend 1-2 days in bed after your operation.

After the procedure, be sure to follow your doctor's instructions .

  • Keep your incision clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You can expect to resume your normal activities within about six weeks of surgery.
  • There is expected to be a dramatic improvement in your overall ability to walk or exercise.
  • Follow your doctor’s directions regarding when you can begin to drive, exercise, lift things, and otherwise exert yourself.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of 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
In case of an emergency, call for medical help right away.