Peripheral artery disease (PAD) is a condition in which the arteries that supply blood and oxygen to the lower extremities become narrowed and hardened. Typically, this condition is caused by the build-up of plaque and fat on artery walls; which narrows the vessels that connect to the lower extremities. This narrowing of the arteries restricts blood from reaching the legs and feet. Blood clots can also form and completely block the artery. People with PAD may complain of symptoms such as pain while walking; pain at night; rest pain; sores on feet and legs that will not heal; and dead tissue/gangrene.
Peripheral artery disease is often initially treated with medication, exercise, smoking cessation, wound care, and in some cases, angioplasty is performed. For many types of blockages, however, bypass surgery is the best option for treatment. A surgical bypass creates new pathways for oxygen-rich blood to flow into the lower extremities and bypass the blocked arteries.
When is bypass surgery needed?
In most cases, your first treatment approach will be lifestyle changes, medication, and exercise. In many cases, if the person commits to these changes, their condition can improve. But when the patient has pain whenever waking, pain when trying to sleep, sores on the feet and legs that don’t fully heal, and other issues with pain, it may be time to consider surgery. At this point, some patients can have their condition resolved with angioplasty. But in other cases, the best option is to bypass the clogged or blocked arteries.
Generally, bypass surgery would be recommended if a patient has intermittent claudication. This is a tight, aching, or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise, such as walking or climbing a flight of stairs. Beyond claudication, the patient should also have symptoms that are limiting his or her lifestyle or work. Exercise and medicine have been tried but have not relieved your symptoms.
Risks Of Bypass Surgery
As with any invasive procedure, there are risks associated with bypass surgery. Risks include:
- Heart attack
The risk of developing these complications depends on the overall health of the patient prior to surgery. Any concerns should be discussed with a doctor prior to undergoing surgery.
Although bypass surgery improves blood supply to lower extremities, it does not cure underlying peripheral artery disease. Medication and healthy lifestyle changes are strongly recommended to reduce the risk of recurring vascular disease, and the need for additional vascular surgery in the future.
General or spinal anesthesia is administered to the patient during a surgical bypass. There are two locations where a surgical bypass may occur; the leg or the abdomen. A lower extremity bypass is often referred to as; leg bypass, fem-pop bypass, fem-tib bypass, or fem-distal bypass. An abdominal bypass is often referred to as; aortic bypass, aorto-iliac bypass, aorto-femoral bypass, fem-fem bypass, aorto-mesenteric bypass, or ax-fem bypass. The various types of bypasses depend on which blood vessel is being bypassed during the procedure.
During the procedure, an incision about 4-8 inches long is made at the groin or mid-line crease, and again at the endpoint. A natural or synthetic graft is used to create the detour around the blockage. The graft is sewn to the artery at both ends with fine stitches. This procedure may take anywhere from 1.5- 6 hours.
How painful is bypass surgery?
Your abdomen and groin will swell and be painful. You will have pain around your incision site. Your pain will turn a corner after about one week. Numbness and tingling in your foot is common after this surgery. But your foot should not appear mottled or purple or feel cold.
Recovery from Bypass Surgery
After a surgical bypass, most patients experience incision pain/ discomfort for several days. A few weeks after the surgery, patients will be able to return to work and independently complete activities of daily living.
How long do you stay in the hospital after bypass surgery?
This varies with the location and extent of the bypass, but you should expect to spend from 3 to 7 days in the hospital. Probably 1 to 3 of those days will be in the intensive care unit.
What precaution should be taken after bypass surgery?
It’s likely that you will have spent time in the intensive care unit, followed by a regular hospital room. If your signs look good, you’ll then be released to return home.
When you return home you cannot sit for more than 1 hour. When you are sitting, it’s also important to raise your feet and legs on another chair or a stool. When you lie down, place a pillow under the lower part of your leg to elevate it.
What happens to the stomach after bypass surgery?
Your bowels often go to sleep for several days after bypass surgery. This is because the anesthetic used during your surgery paralyzes the bowel, which can lead to constipation for up to a week. Pain medications such as Vicodin or Percocet also cause the bowel to ore more slowly. Food is re-introduced gradually to get them operating normally again. When you return home, you may need over-the-counter medications such as Metamucil or Colace, as well as natural options such as apple or prune juice to get your bowels moving normally again.
What Our Patients Have to Say
“Dr. Dormu genuinely cares about his patients and it shows. He takes his time to educate patients and provides great care! After being misdiagnosed by several specialists he was able to diagnose and treat my vascular conditions. I can’t say enough about what a wonderful surgeon he is! I appreciate the great care I was given by him and his staff!”
What foods should you eat after bypass surgery?
Your diet and lifestyle contributed to your PAD, so moving forward after your surgery you’ll need to make some serious changes if you want to keep this from happening again. You will need to adopt what is known as a “heart-healthy diet.” We will discuss the nuts and bolts of this diet with you during your consultation and aftercare. These are the basics.
- Limit unhealthy fats and sodium.
- Avoid sugary foods.
- Avoid processed foods.
- Eat a variety of fruits and vegetables.
- Choose whole grains.
- Choose low-fat protein sources, such as chicken and fish.
- Choose low-fat dairy products.