Are your blood vessels in your legs blocked? Let's learn about Vascular Bypass Surgery in a simple way.

Do you also experience severe pain in your legs, especially when you walk for a short distance? Does the pain subside when you sit for a while and then walk again? Or do you experience numbness in your legs, coldness in your legs, or the feeling that even a small wound takes a long time to heal? These may be signs of some blockage in your body's blood vessel system, especially in the arteries that carry blood to your legs. Today, we are going to talk about a life-changing solution in such cases, a 'bypass' surgery.

First, let's see what vascular disease is.

Simply put, this is a problem with the blood vessel system in our body. Our body has a network of veins that carry blood to every corner. Just like the plumbing system that brings water to our house. There are two types of veins. The veins that carry clean blood (with oxygen and nutrients) from the heart to the rest of the body are called arteries . The veins that carry impure blood from the body back to the heart are called veins .

In a condition called 'Vascular Disease', things like oil and cholesterol build up inside the walls of these arteries, like rust building up in a water pipe, and the blood flow gradually narrows. In medical terms, we call this 'Peripheral Artery Disease' (PAD) . When the blood flow narrows like this, organs that are far from the heart, especially the legs, do not get the oxygen and nutrients they need. That is why symptoms like pain and numbness appear when walking.

So what is bypass surgery?

Okay, now you understand what a blocked blood vessel is. 'Bypass' means creating an alternative route for this blocked blood vessel.

Imagine there is heavy traffic on the Colombo-City Road, and vehicles cannot move. What does the government do then? They build a new expressway to bypass that traffic, right? In the same way, a surgeon uses a new blood vessel or an artificial tube to bypass a blocked blood vessel, creating a new path for the blood to flow without any obstruction.

We call this newly constructed road a 'graft' . This 'graft' is used as:

1. A vein from another part of your body: The most common vein used is the saphenous vein, which is located under the skin of the leg. Sometimes, a vein in the arm can also be used. This is the best option.

2. A pipe made of synthetic material:In cases where a vein cannot be accessed from your body, especially if the blood vessel to be bypassed is very large (for example, the aorta in your abdomen), an artificial tube like this is used.

The main goal of this surgery is to restore blood flow to the legs, relieve pain, heal wounds, and, in the worst case scenario, save you from the risk of amputation.

What are the main types of bypass surgery?

There are several types of bypass surgery. These are named according to the location where the blocked blood vessel and the new artery are connected. Let's look at some of the most common types performed in our country.

What tests should be done before surgery?

Yes, absolutely. Your doctor will do several tests before planning the surgery. This will help them determine exactly where and how much of the blood vessel is blocked.

• Ankle-Brachial Index (ABI):This is a very simple test. They measure your blood pressure in both your ankle and arm (brachial) and compare the two values. If the pressure in your leg is much lower than the pressure in your arm, it means there is some obstruction to the blood flow to your leg.
• Vascular Ultrasound: This is a painless scan, similar to the one done when you have a baby. It can clearly see how the blood is moving through the blood vessels, whether there are any blood clots, and where they are blocked.
• Other tests: Sometimes your doctor may also decide to check your heart condition. This is because many people who have problems with the blood vessels in their legs may also have problems with the blood vessels in their heart.

What happens on the day of the surgery?

This surgery is done in a hospital, in an operating room. You have nothing to be afraid of. The doctors and nursing staff will take good care of you.

1. Anesthesia: First, an anesthesiologist will examine you and give you the necessary medication to keep you in a deep sleep throughout the surgery. This is called 'General Anesthesia' .

2. Surgery: After you are asleep, the surgeon makes several small cuts in your skin to access the blood vessels in question. The location and size of these cuts will depend on the type of bypass you are having.

3. Connecting the bypass: Next, the doctor takes the selected 'graft' (either your own vein or an artificial tube) and connects it to the healthy artery above and below the blockage using very fine stitches.

4. Closing the incisions: After the new path is created, the blood flow is checked and the incisions made in the skin are closed again with stitches.

This entire process can usually take anywhere from two to six hours , depending on the complexity of the bypass surgery you are having.

Are there any risks to this surgery?

As with any surgery, there are risks and complications that can occur. However, these risks can be minimized under the supervision of a skilled medical team. The risk of complications is slightly higher, especially in people with underlying medical conditions such as heart disease, kidney disease, and/or diabetes.

What happens after the surgery? How is the recovery time?

After the surgery, you will need to stay in the hospital for a few days. During this time:

• You will be given painkillers.
• Anticoagulants will be given to prevent blood clots in the new graft.
• The nursing staff will clean and take good care of your wounds.

The most important thing is to get out of bed and start walking as soon as possible. This may be a little difficult at first, but it is essential to walk gradually, as advised by your doctor and a physiotherapist. This will improve blood circulation and help you recover faster.

Even after you go home, you will need to gradually get back into your normal routine. You may have to stop lifting heavy weights and doing strenuous activities for a while.

To keep the graft healthy for a long time, you will need to change your lifestyle.

• If you smoke, stop today: Smoking is the leading cause of graft failure.
• Control diabetes, high blood pressure, and cholesterol: Take the medications prescribed by your doctor on time.
• Eat a healthy diet: reduce oil, salt, and sugar. Eat more vegetables, fruits, and greens.
• Exercise as directed by your doctor: Even simple exercise like walking daily is very beneficial.
• Go to clinics on time: Meet with your surgeon and check the condition of the graft regularly.

When should I see the doctor again?

If you experience any of the following symptoms after surgery, call your doctor immediately.

If you experience sudden chest pain, difficulty breathing, or sudden, severe leg pain accompanied by cold, pale legs, go to the nearest hospital's Emergency Department (ETU) immediately.