Peripheral vascular surgery is the surgical treatment of peripheral artery disease (PAD). In PAD, the blood vessels leading to the arms and legs are narrowed or clogged, so blood has a hard time getting through. Blood carries oxygen, which is essential for the normal functioning of all the tissues of the human body. If PAD decreases blood flow to your arms or legs, you may experience pain and difficulty with movement. Decreased blood flow to the limbs also increases the risk of tissue death, which may require amputation. Doctors recommend peripheral vascular surgery for patients with PAD that have not responded to noninvasive treatments. Common forms of peripheral vascular surgery include endarterectomy, or the surgical removal of the interior lining and blockages within an artery, and peripheral vascular bypass surgery, which creates a new pathway for blood to reach the affected limb. Other names for peripheral bypass surgery include leg bypass surgery and lower extremity bypass surgery. The goals of peripheral artery interventions are to improve circulation, decrease pain, improve limb function, and prevent amputation. Peripheral vascular surgery is used to treat peripheral artery disease, which is a form of peripheral vascular disease. It is typically considered when noninvasive treatments are not sufficient to preserve blood flow to limbs. Healthy lifestyle changes and prescription medicines are usually the first-line treatment for PAD. If symptoms persist or worsen, a vascular specialist may perform angioplasty—the use of a tiny balloon to expand the space for blood to flow inside the blood vessel. If non-coronary angioplasty and other treatments do not provide enough symptom relief, or if multiple vessels are blocked, your doctor may need to perform peripheral vascular surgery. All medical treatments have risks and benefits. Talk with your doctor about your PAD treatment options and the risks and benefits of peripheral vascular surgery. A vascular surgeon—a surgeon who specializes in surgeries involving veins and arteries—performs peripheral vascular surgery. The surgical team in the operating room includes an anesthesiologist or nurse anesthetist, registered nurses, and technicians. The surgeon may also communicate with your other healthcare providers, including your primary care provider and cardiologist (heart doctor), if you see one. The details of your surgery will depend on which surgical procedure is performed. Endarterectomy During an endarterectomy, the surgeon opens the affected blood vessel and scrapes out any plaque blocking the vessel. The surgeon may also remove diseased portions of the blood vessel and reconnect the healthy sections to facilitate blood flow. You and your surgeon or anesthesiologist will discuss your anesthesia options—either general or regional anesthesia. With general anesthesia, you’ll be asleep throughout the procedure. For regional anesthesia, you’ll be awake and alert, but unable to feel anything at the surgical site. You will likely have a sedative to keep you calm and relaxed. An endarterectomy usually takes about 2 to 3 hours in the operating room, with additional time spent in the recovery room after surgery. Bypass Surgery During peripheral vascular bypass, your surgeon creates a new route for blood flow. Your surgeon will use either a portion of one of your healthy blood vessels or a blood vessel made of synthetic fabric to create the new route and bypass the blocked and diseased artery. The decision to use a natural or artificial blood vessel depends on your overall health and the health of your blood vessels. If the bypass will use one of your healthy blood vessels, you may have more than one surgical incision. Often, surgeons will use a blood vessel from the affected extremity, but sometimes they must use one from the opposite leg or arm. The surgeon attaches the graft—the natural or synthetic vessel—to your affected blood vessel above and below the blockage. When blood is flowing through the new vessel, the surgical team closes the incision. Peripheral bypass surgery is performed under general anesthesia and takes 2 to 4 hours. What to expect the day of your peripheral vascular surgery In general, this is what happens the day of your surgery: A preoperative nurse will be with you to answer your questions, make sure you understand and sign the surgical consent form, and help you prepare for surgery. Your anesthesiologist or nurse anesthetist will ask about your medical history and explain the type of anesthesia you will have. A nurse will start an intravenous (IV) line to provide fluids and medications. You may receive a sedative via your IV to help you relax. A surgical team member will take you to the operating room and the anesthesiologist will start your anesthesia. During surgery, the anesthesiologist will monitor your vital signs and other critical body functions. After surgery, you will be in a recovery room, where nurses will monitor your vital signs until the effects of anesthesia wear off. A nurse or assistant will transfer you to a hospital room to continue your recovery. Your nurse will set up pain control measures as directed. 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. If one develops in a deep vein in the leg or pelvis, it can travel to one of your lungs causing a pulmonary embolism. Infection Potential complications of peripheral vascular surgery Most peripheral vascular surgeries are successful, but potential complications include: Heart attack Nerve damage Impaired wound healing Bypass graft failure Reducing your risk of complications You can reduce your risk of certain complications by: Stopping smoking at least 3 weeks before surgery. Smoking increases the risk of blood clots. Telling all members of your care team if you have allergies Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain Taking your medications exactly as directed before and after surgery You can prepare for peripheral vascular surgery by: Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. Several members of your care team may ask you about medicines, so 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 will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed. These tests help ensure you are in good overall health for surgery. Taking or stopping medications exactly as directed. You doctor will give you specific instructions about taking your medications. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Following all instructions about eating and drinking before surgery. Well in advance of surgery, ask your doctor what activity restrictions you will have. Ask friends or family members to help you at home the first few days. You may also need a ride home from the hospital. Questions to ask your doctor The more you know about your surgery, the less anxious you’ll be. Here is a list to questions to ask your doctor about peripheral vascular surgery: Why do I need peripheral vascular surgery? Are there other PAD treatment options? What surgery do you plan to perform—endarterectomy or bypass surgery? Why is that procedure the best choice for me right now? For bypass surgery, will you graft one of my veins or a synthetic vessel? How many of these procedures do you perform on a monthly basis, and how frequently do you encounter complications? Do you have outcomes data you can share with me? What medication plan should I follow before and after the surgery? When can I go home? What restrictions will I have after the procedure? When can I return to work and other activities? What kind of assistance will I need at home? Will I need a ride home? How will my pain be managed? When and how should I contact you if I have questions or concerns? Ask for numbers to call during and after regular hours. Knowing what to expect makes it easier to plan and prepare for a successful recovery. How long will it take to recover? After an endarterectomy, most people spend 1 to 2 days recovering in the hospital. The length of your hospital stay depend on your overall health and whether or not you experience complications. People who have bypass surgery spend 3 to 8 days in the hospital after surgery. You may be in an intensive care unit (ICU) room the first few days. Your care team will get you moving as soon as possible to facilitate healing. Expect to be out of bed the day after surgery; within 48 hours of surgery, your nurse and a physical therapist will help you walk. Walking encourages blood flow and prevents common postoperative complications, such as pneumonia. Will I feel pain? You will have pain, swelling and possibly bruising at your incision sites. Your care team will give you pain medicine. If you have bypass surgery, you may also experience numbness and tingling in your affected limb. That’s normal, but tell your nurse if your limb feels cold or appears purple or mottled in color. When should I call my doctor? It is important to keep your follow-up appointments after peripheral vascular surgery. In addition to monitoring blood flow in your legs, your doctor needs to check your surgical incisions and make sure they are healing properly. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: Bleeding Increased pain Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing Chest pain, chest tightness, chest pressure, or palpitations Fever. A low-grade fever—lower than 101 degrees Fahrenheit—is common after surgery, but follow your doctor's specific instructions about when to call for a fever. Unusual swelling, redness or warmth around your incision Discoloration of your affected limb How might peripheral vascular surgery affect my everyday life? Because activity is so important to full healing, your doctor may have you work with a physical therapist in the weeks after surgery. The therapist will help you safely and gradually increase your activity level. After you fully recover, you will likely have less pain than you had before surgery. You may find it easier to move around comfortably too. Your doctor may ask you to adjust your lifestyle. Regular exercise and a healthy diet help keep blood vessels healthy. Permanently quitting smoking is a good idea too. Your healthcare provider can refer you to a smoking cessation program. Your doctor will discuss specific limitations and recommended lifestyle changes with you both before and after your surgery.