Peripheral Vascular BypassBy
Sarah Lewis, PharmD
What is peripheral vascular bypass?
A peripheral vascular bypass is the surgical creation of a new route for blood to flow around narrowed or blocked arteries outside the heart. It is a treatment for peripheral artery disease (PAD). Peripheral vascular bypass involves taking healthy veins from other places in your body to replace the diseased blood vessel. Your doctor may also replace the diseased vessel with a synthetic (artificial) vessel. The newly created blood vessel is called a graft.
Peripheral vascular bypass is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a peripheral vascular bypass.
Types of peripheral vascular bypass
The types of peripheral vascular bypass procedures include:
Aortic bypass is the bypass of a blocked section of your aorta. Your aorta is the main artery leaving your heart. It passes down through your abdomen (belly).
Axillary artery bypass is the bypass of the artery in your underarm.
Femoral artery bypass is the bypass of the artery in your thigh.
Iliac artery bypass is the bypass of the artery in your pelvis.
Popliteal artery bypass is the bypass of the artery in your knee.
Tibial artery bypass is the bypass of the artery in your lower leg.
Other procedures that may be performed
Your doctor may perform other procedures in addition to a peripheral vascular bypass. These include:
Angiography, which is a procedure that allows your doctor to take a picture or image (called an arteriogram) of your artery
Doppler ultrasound, which produces images of the flow of blood through your artery
Why is peripheral vascular bypass performed?
Your doctor may recommend peripheral vascular bypass to treat peripheral artery disease (PAD). PAD is a type of peripheral vascular disease (PVD). PAD is the narrowing or blockage of arteries outside your heart.
Arteries are blood vessels that carry blood from your heart to your organs and tissues. Fatty deposits can build up on artery walls and harden into a substance called plaque. As plaque builds, it narrows and hardens the artery. This is called atherosclerosis. With time, atherosclerosis can lead to blockage of the artery and blood will not flow through it properly. In addition, a blood clot is more likely to form in an artery that has plaque buildup. Diabetes and smoking are also risk factors for PAD.
Your doctor may only consider a peripheral vascular bypass for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a peripheral vascular bypass.
Your doctor may recommend a peripheral vascular bypass if:
Medications and exercise therapy have not improved your PAD symptoms.
You are not a candidate for angioplasty and stenting, which opens a narrowed or blocked artery.
You have an infection or gangrene in the affected extremity.
You have pain even when resting the affected extremity.
You have problems performing daily activities or walking because of your PAD symptoms.
You have skin ulcers, sores, or wounds that will not heal on the affected extremity. You may need to have more blood flow to the area for the wounds to heal.
Who performs peripheral vascular bypass?
A vascular surgeon perform peripheral vascular bypass. Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.
How is peripheral vascular bypass performed?
Your peripheral vascular bypass will be performed in a hospital. A peripheral vascular bypass is an open surgery. Open surgery involves making an incision that allows the surgeon to directly view and treat the diseased artery.
Your vascular surgeon will first choose and remove a suitable vein to use as a graft. If there is not a suitable vein, the surgeon will use a synthetic vessel for grafting. Your surgeon will make an incision to expose the blocked or narrowed artery. The graft is attached above and below the blockage to allow blood to flow around it. Your surgeon will verify that blood is flowing as expected through the graft by using Doppler ultrasound and angiography.
Types of anesthesia that may be used
Your surgeon will perform a peripheral vascular bypass using a either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your peripheral vascular bypass
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of peripheral vascular bypass?
As with all surgeries, a peripheral vascular bypass involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of peripheral vascular bypass
Complications of peripheral vascular bypass include:
Bypass failure causing you to need another bypass graft operation
Nerve damage, which can lead to pain or numbness in the affected extremity
Organ or bowel damage if the surgery involves your abdomen
Recurrence of artery blockage or narrowing
Sexual problems if nerve injury affects nerves in your groin
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
Quitting smoking. This causes poor wound healing and progression of PAD.
How do I prepare for my peripheral vascular bypass?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a peripheral vascular bypass by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Pre-operative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Talk to your doctor about how to control your blood sugar if you have diabetes. Good blood sugar control can help decrease your risk of complications with a peripheral vascular bypass.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need peripheral vascular bypass? Are there any other options for treating my condition?
Will you use one of my veins or a synthetic vessel for the graft?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my regular medications?
How will you treat my pain?
When should I follow up with you?
How should I contact? Ask for numbers to call during and after regular hours.
What can I expect after my peripheral vascular bypass?
Knowing what to expect can help make your road to recovery after peripheral vascular bypass as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may then stay in a regular hospital room or an intensive care unit (ICU). ICUs provide 24-hour monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. You may have tubes and wires attached to your body when you wake up. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may be up and walking within a few hours after a peripheral vascular bypass in your arm or leg. There may be swelling or bruising of your arm or leg after surgery. This will improve as you recover. A typical hospital stay for this type of surgery ranges from two to four days. If your surgery involved arteries in your abdomen, you will likely stay in the ICU for 24 for 48 hours. A hospital stay of up to 10 days may be required for this type of peripheral vascular bypass.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor will likely refer you to an exercise rehabilitation program to help you recover. Full recovery takes four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your peripheral vascular bypass. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a peripheral vascular bypass. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bloating or pain in your abdomen or belly
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Coughing up blood or yellow or green mucus
Feeling of coolness or numbness in the affected extremity, or the extremity turns colors, is pale, or feels cool to the touch
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might a peripheral vascular bypass affect my everyday life?
A peripheral vascular bypass may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. For example, peripheral vascular bypass may help you regain your ability to walk without pain.
A peripheral vascular bypass will not prevent peripheral vascular disease from coming back. You can make changes in everyday life that may help prevent or delay recurrence of peripheral vascular disease, such as:
Eating a heart-healthy diet
Getting regular exercise
Maintaining a healthy weight
Practicing stress management techniques
- Quitting smoking
Taking blood thinning medications, such as aspirin or clopidogrel (Plavix), as directed by your healthcare provider
Treating other related conditions, including high blood pressure, high cholesterol, and diabetes
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