Do you experience pain in your legs, especially in the calf area, when you walk? Do you feel like your legs are losing their power after walking for a short distance, and it seems to decrease when you rest? Perhaps a blood vessel in your leg is gradually becoming blocked. We call this condition Peripheral Artery Disease (PAD). Today we are talking about a special surgery that is performed when this condition is severe and cannot be controlled with other treatments.
What is Peripheral Artery Bypass?
Simply put, it's like building a new bypass to avoid heavy traffic on a road. Cholesterol and other fatty substances build up in the arteries that carry blood to our bodies, especially to our legs, and form a "plaque." Over time, this plaque builds up and blocks the blood vessels. This deprives the tissues in our legs of the oxygen and nutrients they need.
So, in Peripheral Artery Bypass surgery, the surgeon creates a new path to bypass the blocked blood vessel. This involves using a healthy blood vessel from your own body (usually a vein from your leg) or a graft. This is connected above and below the blocked area, creating a new path for blood to flow.
Who really needs this surgery?
This surgery is not for everyone with PAD. Your doctor will first try medications, lifestyle changes (such as quitting smoking, exercising, and dieting), and possibly other treatments that involve small incisions (such as angioplasty or stenting).
This surgery is usually recommended for people who have had no success with any of these methods and who have severely blocked a large portion of their blood vessel.
There are several main reasons to consider this surgery.
| Symptom | What does this mean? |
|---|---|
| Leg pain when walking or at night | This pain occurs when the muscles are deprived of oxygen due to reduced blood flow. If the pain is so severe that you can't sleep at night, it's a serious condition. |
| Non-healing wounds on the legs | Due to poor blood circulation, wounds do not receive the nutrients they need to heal. Even a small scratch can turn into a large wound. |
| Tissue death (Gangrene) | This is the most severe stage. When the blood supply to the leg is almost completely cut off, the toes or parts of the foot turn black and begin to die. If surgery is not performed at this point, the leg may even have to be amputated. |
What should you do before surgery?
When the doctor decides to perform this surgery on you, he will perform several tests to check your general health.
- Electrocardiogram (EKG): View the electrical activity of the heart.
- Ultrasound Scan: See exactly where the blood vessels are blocked and how severe it is.
- Blood tests: Check things like blood sugar, cholesterol, and kidney function.
- Stress test: This test is sometimes done to see how the heart works during exercise.
The most important thing is that if you are a smoker, you should stop smoking completely a few weeks before your surgery. Smoking constricts your blood vessels and increases the risk of complications after surgery. You will also need to avoid eating or drinking after midnight the night before your surgery and stop taking any medications your doctor has told you to stop.
How is the surgery performed?
You will be given general anesthesia (a complete loss of consciousness) so that you will not feel any pain during the surgery. Then, the surgeon will make 4-8 inch long incisions above and below the blocked blood vessel. If a healthy vein in your leg is being used to create the bypass, a separate incision will be made for that as well.
The graft is then carefully sewn to healthy blood vessels above and below the blockage. Once the new blood supply is created, the incision is closed with stitches or staples. The entire procedure can take anywhere from two to six hours, depending on the complexity of the surgery.
What happens after the surgery?
After the surgery, you will need to stay in the hospital for about 2-5 days. During this time, the doctors and nurses will regularly check your pulse, blood pressure, and fever. Most importantly, they will regularly check to make sure that the blood is flowing well to the operated leg. They will give you pain medication.
After you go home, the doctor will prescribe several medications for you to continue taking.
- Statin type medications (lower cholesterol).
- Medications such as Aspirin or Clopidogrel (to prevent blood clots in the new transplant).
It is normal to experience a loss of appetite, pain or numbness in the incision sites, some swelling in the legs, and muscle pain when walking in the first few weeks after going home. These will gradually decrease over time. It can take about 6-8 weeks to fully heal.
What are the benefits and risks of this surgery?
Like every major surgery, this one has benefits as well as some risks.
| Advantages | Risks/Complications |
|---|---|
| Relief of severe leg pain that has not been relieved by other treatments. | Blood clots. |
| Unhealed wounds begin to heal. | Infections in cuts. |
| Eliminate the risk of losing a leg due to gangrene. | Excessive bleeding. |
| Long-lasting results (60%-85% of transplants are still functioning well even after 5 years). | Damage to the nerves in the area of surgery. |
| Improved quality of life and walking ability. | Small risk of heart attack (about 3% of surgeries). |
Most people do not develop serious complications. However, people over the age of 70 and those with other medical conditions, such as diabetes or kidney disease, are at a slightly higher risk of complications. Sometimes, even a newly made graft can become blocked after many years. If that happens, treatment may need to be repeated.
After you go home, if you develop a fever, feel cold, have pus-like fluid coming out of the surgical site, or if there is a sudden change in the color, shape, or sensation of your leg, see your doctor immediately or go to the hospital's Emergency Department (ETU) without delay.
Take-Home Message
- Peripheral Artery Bypass surgery is a major surgery performed on people with severely blocked blood vessels in their legs that have not responded to other treatments.
- If you smoke, it is essential to completely quit before and after surgery to achieve a successful outcome.
- Take the medication your doctor prescribes on time. Don't forget to take your blood thinners, especially.
- Don't miss any clinic appointments after surgery. Your doctor should regularly check the blood circulation in your legs.
- If you notice a fever, discharge from the incision, or a sudden change in your leg, seek medical advice immediately.
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