Is your blood flow to your legs reduced? Let's talk about Aortobifemoral Bypass surgery

Do you feel a sharp pain or tightness in your legs, especially in the thighs and buttocks, when you walk for a short distance? The pain goes away after a while, but comes back when you start walking again? Or do you develop wounds on your legs for no apparent reason and they take a long time to heal? If you have these symptoms, your doctor may have talked to you about surgery. You may have been a little scared when you heard the name. Today we are talking about that, a surgery called Aortobifemoral Bypass. Don't worry, let's explain this very simply.

Simply put, what is Aortobifemoral Bypass?

Imagine that a main road in a city is completely blocked due to traffic. There is no way for vehicles to get through. What do you do then? We avoid that blocked area and build a new 'bypass' road to get to the other side, right? That's what this surgery does.

Aortobifemoral bypass is a surgery that involves the blood vessels in our body. In this, surgeons create a new route, called a bypass , to bypass the blocked or narrowed areas of the main blood vessels in our abdomen. This restores blood flow to our legs.

In this surgery, doctors use an artificial blood vessel, called a graft . This is usually made of a material like polyester. Let's understand how it got its name:

• "Aorto" refers to the largest blood vessel in our body, the aorta . It starts at the heart and then goes through the chest and into the abdomen.
• "Femoral" refers to the femoral arteries, which start in our groin and run along our thighs to behind our knees.
• "Bi" means 'two'. That means this graft connects to both femoral arteries in both of your legs.

This graft looks like an upside-down "Y." The single end at the top is connected to the lower part of the aorta in the abdomen. The two legs of the Y are connected to the femoral arteries in the legs. This way, blood can bypass the blockage and flow more easily to the legs.

Why do we need this kind of surgery?

This surgery is mainly done as a treatment for a condition called Aortoiliac occlusive disease . Although the name may sound a bit complicated, the story is very simple. What happens is that cholesterol and other fatty deposits (plaque) build up over time in the main blood vessels in our abdomen and pelvis. The main blood vessels affected in this way are:

• Abdominal aorta: This is the part of the aorta that goes down from inside our stomach.
• Iliac arteries:These begin near the groin where the aorta divides into two. These are the ones that travel to the groin area and become the femoral arteries.

When plaque builds up inside these blood vessels and narrows them, the lower parts of our body, such as the legs, feet, and other organs in the pelvis, do not receive the necessary amount of oxygenated blood. When this condition becomes severe, various complications can occur.

Is this a serious surgery? Are there other options?

Yes, aortobifemoral bypass is an open surgery performed through a large incision in the abdomen. Therefore, it is considered a major, or major, surgery.

But nowadays, with the advancement of technology, there are alternative treatments for this. One of the main ones is a method called aortoiliac stenting with bifurcation reconstruction (AISBR) . This belongs to the category of endovascular surgery .

Simply put, this involves inserting a cannula into the blood vessel through a small hole in the groin, going to the blocked area, and placing a small mesh-like tube (stent) through it to widen the blood vessel again. This method has fewer surgical complications and a shorter hospital stay.

Your doctor will decide which option is best for you. Typically, stenting is recommended for people who are at high risk for major surgery due to other medical conditions. However, sometimes, depending on the severity of the blockage, open surgery may be necessary. So talk to your doctor about your options and the pros and cons.

How do we prepare before surgery?

A major surgery like this requires a lot of preparation. Your medical team will give you the necessary instructions. In general, you should take care of these things.

• Quitting smoking: If you are a smoker, you should stop completely at least 3-4 weeks before surgery. Quitting smoking is very important for the success of the surgery, as well as for the health of your heart and blood vessels later on.
• Tell your doctor about any medications you are taking: If you are taking medication for things like diabetes or high blood pressure, you should tell your doctor about it. Some medications may need to be stopped or the dosage changed before surgery.
• Fasting before surgery: You will be instructed to avoid eating or drinking after midnight the night before surgery. Follow these instructions exactly.
• Getting the necessary tests: You will need to undergo several tests to confirm your health before the surgery.
• Ankle-brachial index (ABI): A test that measures blood pressure in the legs.
• Vascular ultrasound (Doppler scan): A scan to look closely at the flow of blood inside the blood vessels and any blockages.
• Tests like ECG and Echo that check the health of the heart and coronary arteries.

What actually happens during the operation?

You will not feel anything during the surgery, as you will be under general anesthesia. The surgical team will follow these steps:

1. Anesthesia: You are put into a deep sleep.

2. Making the incisions: First, a large incision (laparotomy) is made along the length of the abdomen to reach the aorta. Then, two more incisions are made at the top of the groin to reach the femoral arteries.

3. Graft insertion:The surgeon takes the "Y"-shaped artificial blood vessel and sews the top end of it above the blockage in the aorta. The bottom two legs of the Y are sewn below the blockage in the femoral arteries.

4. Closing the incisions: After the new bypass is created, the incisions made in the abdomen and groin are closed with stitches or staples.

This entire surgery can usually take between 2 and 6 hours .

What happens in the hospital after surgery?

After the surgery, you will need to stay in the hospital for between 4 and 7 days. During this time, the medical team will take very good care of you.

• You will be kept in the intensive care unit (ICU) or a specialized ward and closely monitored for any complications, especially infections.
• I regularly check to see if the blood circulation in your legs is good.
• They will gradually help you walk. First a short distance, then increase the distance day by day.
• Painkillers are given to control the pain.

What are the success and risks of this surgery?

This surgery is highly successful. According to statistics, between 80% and 95% of surgeries successfully maintain blood flow for 5 years. At 10 years, the success rate is between 74% and 86%.

As with any major surgery, there are risks and complications that can occur. Before you panic, remember that the medical team will do their best to reduce the likelihood of these occurring.

Possible complications:

• Heart attack
• Stroke
• Excessive bleeding
• Blood clots
• Surgical wound infections
• Graft infection
• Kidney failure
• Lung failure

Talk openly with your doctor about these risks before surgery and ask any questions you have.

Recovery and precautions after going home

It may take 2 to 3 months to fully recover, but you should be able to gradually resume normal activities within 4 to 6 weeks.

The incisions may be painful for the first few weeks. Use the painkillers your doctor prescribes for this.

• Take your medication exactly as prescribed: Take all medications prescribed by your doctor at the right time and in the right dosage.
• Keep wounds clean: Follow your doctor's instructions carefully about washing and applying medication.
• Exercise:The best exercise to do in the early stages is walking. Gradually increase the distance you walk each day. But don't go any harder than your doctor recommends.
• Avoid lifting weights: Avoid lifting weights completely for a few months.

Ask your doctor when you can start driving again, going to work, and doing strenuous exercise.

What time should I call the doctor?

If you develop any of the following symptoms after returning home, call your doctor or go to the hospital immediately .

What to do in an emergency? (Emergency)

If you experience any of the following symptoms of a heart attack or stroke , call the 1990 ambulance service without delay or go to the Emergency Treatment Unit (ETU) of the nearest hospital.

Symptoms of a heart attack

• Pain, tightness, or discomfort in the center of the chest.
• Difficulty breathing.
• Nausea, stomach discomfort.
• Heart palpitations.
• Extreme fatigue.
• Dizziness, loss of consciousness.
• Excessive sweating.

Symptoms of a stroke

• Numbness or weakness on one side of the body (face, arm, or leg).
• Difficulty speaking or slurring words.
• Sudden loss of vision, one or two visions.
• Sudden severe headache.
• Difficulty walking, loss of balance.

Facing a major surgery can be emotionally stressful. That's normal. Talk about your fears and concerns with your family, as well as your doctor and medical team. Getting all the information you need and going into it with good mental preparation will help a lot with the healing process.