Aorto bifemoral bypass is a surgery used to create a new path for a clogged blood vessel in the abdomen or groin area. The surgery bypasses the circulation with a new artery around a blocked artery from abdominal aorta to common femoral artery in the groin to restore the circulation and relieve symptoms. The formation of blood clots and atheroma in the abdominal and pelvic aortas may block the blood supply to the legs which may cause severe mobility problems. The symptoms of blocked arteries will be pain the legs, calfs, thighs and buttocks known as intermittent claudication. If the symptoms were persisted they may cause severe pain during night time called critical limb ischemia. The other symptoms of critical limb ischemia are arterial ulcers and gangrene which may lead to leg amputation. Aortofemoral bypass surgery will be done to restore the blood supply to the legs which reduces the pain, heal the ulcers and to reduce the risk of leg amputation.
Indications for Aortofemoral Bypass
- Severe pain in the limbs.
- Ulcers which are not healing in the extremities.
- Persistent severe claudication symptoms.
- Abdominal aorta occlusion.
- Infertility caused by impotence.
- Atheroma of abdominal aorta or iliac arteries.
- Blood tests.
- Analysis of urine.
- The blood pressure in both the arms and legs can be measured with ankle brachial test in which low pressure detection is an indication of blockage.
- Doppler ultrasound to detect the blockages.
- CT, MRI scan or Angiography.
Before the Procedure
- Initial blood screenings, X rays will be advised.
- The complete list of medications currently being used should inform to the medical staff to prevent drug interactions.
- Allergic to specific medicines or consuming blood thinners, herbal supplements should be informed.
- Family history of bleeding disorders should be informed.
- The patient has to inform about having any disorders such as diabetes, high blood pressure, chest pains, or heart attack.
- Earlier diagnosis of blood clots in legs or lungs.
- List of surgical procedures undergone in the past.
- The patient will be advised not to eat or drink 6-8 hrs prior to surgery.
- The surgeon will explain about the surgery and other complications.
- The consent form from the patient with his signature will be taken.
- The patient should stop smoking completely as it may cause additional risk of heart attack and lung issues.
- A disposable gown will be given to the patient along with a bracelet with personal details attached.
- The surgeon will advise to stop some medications prior to this surgery which will affect the clotting time after the procedure.
- Some medications will be prescribed by the anaesthesia professional before the surgery.
During the Procedure
- The patient will become sedated after general anaesthesia.
- The surgeon doctor will make a cut in the abdomen area.
- Another one will be made in the groin area.
- A Y shaped tube will be inserted and the single end will be attached to the artery in the abdomen.
- The two other opposing ends will be connected to the femoral arteries in the legs.
- Using the graft blood flow will be redirected which will flow through it or bypass the blockage area.
- Restoration of blood flow to the legs will happen then the incisions will be properly closed.
After the Procedure
- After the surgery patient will be transferred to the recovery room for up to 12 hours.
- The nursing staff will monitor the pulse, blood pressure, breathing rate and urine output.
- The catheter will be removed after 24-48 hours.
- The usual hospital stay will be 4-7 days.
- The pulse in the legs will be checked every hour to ensure the proper working of the grafts.
- Pain medications will be given for up to a week
- Initial walking for a period of 10 minutes should be started after return to home.
- The amount of walking time will be gradually increased every day.
- The legs should be raised while in a sitting position.
- Tiredness will be lost several days after the procedure.
- Normal activities can be resumed after 4 to 6 weeks. It will take 2 to 3 months to fully recover.
- Strenuous activities should not be done for 6 months.
- Proper rest should be taken for 4-6 weeks to join back the work which also depends on the activities performed at the work place.