Do you sometimes experience severe pain in your legs, especially in your thighs and calves, when you walk? Do you have to stop because of this pain when you walk a little distance? Or do even small wounds on your legs take a long time to heal, do your legs feel cold to the touch, and have a change in color? The main reason for these things can be a blockage in the blood vessels (arteries) that carry blood to your legs. So, when this condition becomes severe, one of the main and most effective treatments that doctors recommend is bypass surgery. Let's talk about this today.
What is Vascular Bypass Surgery?
This is very simple. Imagine that a main road in a city is completely closed for maintenance. Then vehicles cannot get through, right? So what do the authorities do? They bypass that road and build a new side road, a bypass road, for vehicles to reach their destination.
This is exactly what happens in our bodies during bypass surgery. When a major artery that carries blood to your leg becomes so blocked by things like cholesterol that it completely blocks blood flow, the surgeon creates a new path for the blood to flow around the blocked artery.
A 'graft' is used to create this new pathway. This graft can be a vein from another part of your body (often from your leg). Or it can be a specially made synthetic material. The main goal of this surgery is to restore good blood flow to your leg, keep the tissue alive, and save you from the serious risk of amputation in the future.
Who needs this surgery?
This surgery is usually needed for people who have very severe blockages in the arteries that supply blood to their legs. This condition is medically known as `Peripheral Artery Disease (PAD).` When this `PAD` disease becomes severe, the blood supply to the legs is reduced so much that the tissues in the legs begin to die. This is called `Critical Limb Ischemia`.
Simply put, without blood to the leg, the leg itself is in danger. This bypass surgery is often used to save the legs of patients in such critical conditions.
What are the main types of bypass surgery?
There are several types of these surgeries. They are named according to the artery where the bypass begins and the artery through which the blood is rerouted. You can get a good idea of this from the table below.
| Name of the surgery (Type of Bypass) | What is happening is simply |
|---|---|
| Aortobifemoral bypass | Starting from the large main artery (Aorta) in the abdomen, it splits into two like an upside-down 'Y' and connects to the main arteries (Femoral arteries) in the thighs of both legs. |
| Femoral-popliteal bypass | It starts from the femoral artery in the groin and connects to the popliteal artery above or below the knee. |
| Femoral-tibial bypass | It starts from the femoral artery in the groin and connects to the tibial arteries below the knee. |
Preoperative tests
Yes, absolutely. Your doctor will perform several tests before planning your surgery. The main ones are:
- Ankle-brachial index: This measures the blood pressure in your arm and ankle and compares the two. This can give you an idea of how much blood flow to your legs has decreased.
- Vascular Ultrasound (Doppler Scan): This is a painless scan that can accurately look at the blood flow inside the veins and any blockages.
Additionally, since many people with leg vein problems may also have problems with their heart veins, doctors will also check your heart health before surgery. This is very important for your safety.
How the surgery is performed and possible risks
The surgery takes place in a hospital operating room. First, you are given general anesthesia (an anesthetic). So you won't feel anything during the surgery. Then, the surgeon makes several incisions (incisions) in the skin to reach the necessary veins. Next, the appropriate graft is taken, bypassed the blocked vein, and a new route is created with very fine stitches. This surgery can usually take between two and six hours.
As with any surgery, there are some risks involved, especially for people with underlying medical conditions such as diabetes, heart disease, or kidney disease.
| Possible risk/complication |
|---|
| Bypass graft failure - This means that the blood flow through the graft is reduced or blocked again. |
| Bleeding from cuts. |
| Wound or graft infection. |
| Nerve damage, numbness, or weakness in the leg. |
| Heart attack. |
| Pneumonia. |
What happens after the surgery?
After the surgery, you will need to stay in the hospital for a few days. You will be given anticoagulants to prevent blood clots from forming inside the newly created graft.
The most important thing is that your doctor may tell you to get out of bed and start walking around a bit. This is very important to keep your blood circulation going and to help you recover quickly. Some people may also need physical therapy. Gradually, you will be able to get back to your normal activities.
Remember one important thing. This surgery will not completely cure your PAD. It will only control the symptoms and save your leg. Over time, these grafts can become blocked again. Graft failure is especially common in people who smoke. Therefore, the success of the surgery depends on your lifestyle.
When do you need to call your doctor immediately?
When you go home after surgery, be very careful about the following symptoms. If you have any of these, immediately inform your doctor or the hospital where you received treatment.
| Warning signs to look out for | |
|---|---|
| If the operated leg has these symptoms: | |
| - New or severe pain | - Cold, pale, or blue legs |
| - Numbness or feeling nothing | - Worsening of leg wounds |
| If there are other common symptoms of complications: | |
| - Fever | - Nausea and vomiting |
| - Redness and warmth around the incisions | - Pus-like fluid draining from wounds |
Take-Home Message
- Vascular Bypass is a surgery that bypasses a blocked blood vessel and creates a new path for blood to flow.
- The main goal of this is to restore blood flow to the leg and save it from the risk of amputation.
- For the success of the surgery and the long-term maintenance of the graft, it is essential to completely abstain from smoking and to properly control diseases such as diabetes and high blood pressure.
- Even after surgery, it is very important to maintain regular contact with your doctor and undergo regular checkups.
- If you notice new pain, numbness, discoloration, or worsening of a wound in your leg, do not ignore it and inform your doctor immediately.
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