Overview

What is Peripheral Vascular Surgery?

This refers to diseases of blood vessels outside the heart and brain. It's often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. There are two types of these circulation peripheral vascular disease :

Functional peripheral vascular diseases:

Functional peripheral vascular diseases don't have an organic cause. They don't involve defects in blood vessels' structure. They're usually short-term effects related to "spasm" that may come and go. Raynaud's disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.

Organic peripheral vascular diseases :

Organic peripheral vascular diseases are caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It's caused by fatty buildups in arteries that block normal blood flow.

Peripheral Vascular disorder :

The term peripheral vascular disease refers to problems in the major arteries and veins outside of the heart. There are two types of vascular disorders: peripheral arterial disease (PAD) and peripheral venous disorder


Included among these conditions are the following:

Arteriosclerosis, in which the artery walls become abnormally thickened or hardened

Arterial occlusion and embolism, in which undissolved material in the bloodstream (such as clumps of clotted blood or tissue fragments) blocks the blood flow in the artery, causing a loss of blood to tissue beyond the blockage

Carotid occlusive disease, in which the carotid arteries (the arteries in the neck that supply the brain with blood) become blocked

Aortic or femoral artery occlusive disease, in which the aorta (the main artery going through the chest and abdomen) or one of the femoral arteries (the main arteries that carry blood to the legs) becomes blocked

Pulmonary embolism, a condition in which blood clots travel to the lungs

Purpose :

Peripheral vascular bypass surgery is performed to restore blood flow (revascularization) in the veins and arteries of people who have peripheral arterial disease (PAD), a form of peripheral vascular disease (PVD). People with PAD develop widespread hardening and narrowing of the arteries (atherosclerosis) from the gradual build-up of plaque.

In advanced PAD, plaque accumulations (atheromas) obstruct arteries in the lower abdomen, groin, and legs, blocking the flow of blood, oxygen, and nutrients to the lower extremities (legs and feet). Rerouting blood flow around the blockage is one way to restore circulation. It relieves symptoms in the legs and feet, and helps avoid serious consequences such as heart attack, stroke, limb amputation, or death.

Risks

Other complications may include:

Normal Results :

A femoropopliteal or femorotibial bypass with an autogenous graft of good quality saphenous vein has been shown to have a 60–70% chance of staying open and functioning well for five to 10 years. Aortobifemoral bypass grafts have been shown to stay open and reduce symptoms in 80% of patients for up to 10 years. Pain and walking difficulties should be relieved after bypass surgery. Success rates improve when the underlying causes of atherosclerosis are monitored and managed effectively.


How is Peripheral Artery Bypass Surgery done in India ?

Surgery to bypass a blocked leg artery can relieve your symptoms. The bypass is done with a graft, a special tube that reroutes blood around a blockage.

Peripheral Bypass India, Peripheral Vascular Bypass Surgery, InformationBypass surgery is an open procedure that requires general anesthesia. In femoropopliteal bypass or femorotibial bypass, the surgeon makes an incision in the groin and thigh to expose the affected artery above the blockage, and another incision (behind the knee for the popliteal artery, for example) to expose the artery below the blockage.

The arteries are blocked off with vascular clamps. If an autogenous graft is used, the surgeon passes a dissected (cut and removed) segment of the saphenous vein along the artery that is being bypassed.

If the saphenous vein is not long enough or is not of good quality, a tubular graft of synthetic (prosthetic) material is used. The surgeon sutures the graft into an opening in the side of one artery and then into the side of the other. In a femoropopliteal bypass, for example, the graft extends from the femoral artery to the popliteal artery. The clamps are then removed and the flow of blood is observed to make sure it bypasses the blocked portion of the affected artery.

Aortobifemoral bypass surgery is conducted in much the same way, although it requires an abdominal incision to access the lower portion of the abdominal aorta and both femoral arteries in the groin. This is generally a longer and more difficult procedure. Synthetic grafts are used because the lower abdominal aorta is a large conduit, and its blood flow cannot be handled by the smaller saphenous vein.

Vascular surgeons prefer the saphenous vein graft for femoropopliteal or femorotibial bypass surgery because it has proven to stay open and provide better performance for a longer period of time than synthetic grafts. Bypass surgery patients will be given heparin, a blood thinner, immediately after the surgery to prevent clotting in the new bypass graft


After Peripheral Vascular surgery :

After bypass surgery, the patient is moved to a recovery area where blood pressure, temperature, and heart rate are monitored for an hour or more. The surgical site is checked regularly. The patient is then transferred to a concentrated care unit to be observed for any signs of complications. The total hospital stay for femoropopliteal bypass or femorotibial bypass surgery may be two to four days.

Recovery is slower with aortobifemoral bypass surgery, which involves abdominal incisions, and the hospital stay may extend up to a week. Walking will begin immediately for patients who have had femoropopliteal or femorotibial bypasses, but patients who have had aortobifemoral bypass may be kept in bed for 48 hours. When bypass patients go home, walking more each day, as tolerated, is encouraged to help maintain blood flow and muscle strength. Feet and legs can be elevated on a footstool or pillow when the patient rests.

Some swelling of the leg should be expected; it does not indicate a problem and will resolve within a month or two. During recuperation, the patient may be given pain medication if needed, and clot prevention (anticoagulant) medication. Any redness of the surgical site or other signs of infection will be treated with antibiotics. Patients are advised to reduce the risk factors for atherosclerosis in order to avoid repeat narrowing or blockage of the arteries.

Repeat stenosis (restenosis) has been shown to occur frequently in people who do not make the necessary lifestyle modifications, such as changes in diet, exercise, and smoking cessation. The benefits of the bypass surgery may only be temporary if underlying disease, such as atherosclerosis, high blood pressure, or diabetes, is not also treated.

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