Artery Bypass To
The main artery coming off
the heart is the aorta. It travels down through the chest and
into the lower abdomen, branching off to various organs along
the way. At just below the navel, it divides into the left and
the right iliac arteries. At the groin, these arteries become
the femoral arteries; and at the knee area, they become the
Sometimes arteries on one
or both sides become partially blocked by cholesterol deposits
(called athero-mas) that prevent enough blood from getting to
the legs. When the arteries become so blocked that tissue cannot
get the blood it needs, ischemia, or a deficiency of blood
Common Signs and Symptoms
- Cramping pain in the
calves, thighs, and buttocks when walking.
- Pain in the toes and
feet, most prominent at night, that gets better with
sitting or standing.
- Very slow healing of
any sore on the leg or foot.
- Thin, shiny skin
over the legs with loss of some hair.
- Pale legs.
- Weak or absent
pulses at the ankles.
Many patients can be treated
medically. This includes the following things:
- Stop smoking.
- Taking off excess
- Starting an exercise
- There is now
medication which can give relief of pain when walking
called cilostazol which is taken twice a day. This is
not advisable for patients who have had congestive heart
If medical treatment
fails to relieve the symptoms, or complications from a lack of a
blood supply occur, then more aggressive treatment is suggested.
This includes surgery and sometimes angioplasty procedures. An
operation is strongly advised in the following circumstances:
- There is severe
disability from the cramping pain in the calf when
walking which does not respond to medication.
- There is pain while
resting, particularly in the feet at night.
- There is a
non-healing ulcer on the leg.
Preparing for Surgery
- Special attention
will be given to the aorta for the presence of an
aneurysm (bulge in the artery) that would indicate any
weakness and widening in the wall. Also the vessels to
the brain, the carotid arteries, may be examined for any
evidence of blockage.
- An arteriogram will
be done to check the location and extent of the
blockage. The skin in your groin will be painted with an
antiseptic solution and the area will be injected with
an anesthetic to make it numb. Then a fine needle will
be inserted through the numbed skin, and a liquid dye
will be injected into your aorta. X-ray pictures will be
taken as the dye passes down to the arteries of your
pelvis and legs. If an ultrasound has already accurately
located the blockage, sometimes the arteriogram can be
obtained in the operating room.
- Shower (and shave)
as usual on the morning of the operation.
- You may be given
medicine that will make you feel drowsy before you are
brought to the operating room.
- You will be given
either general anesthesia, or a spinal, whichever is
- The aim of the
operation is to bypass the blocked area using a graft.
The graft is either a tube made of strong synthetic
material or a section of vein taken from nearby in your
- Incisions will be
made and the graft will be attached to the artery above
and below the blockage. The bypass will allow increased
blood flow to the leg and foot.
- When adequate
circulation is ensured, the incisions are closed.
- You will not receive
a blood transfusion unless it is absolutely necessary.
- You will be taken to
a recovery room. When your blood pressure, pulse, and
breathing are stable, you will be taken to a regular
- The circulation to
your legs will be watched very carefully.
- The next day you
will be helped to stand at the bedside.
- Pain can be
controlled with medicine.
- You should be able
to go home in 2 to 5 days.
- As with any
operation, complications are always possible, some of
them serious. With this type of operation, they can
include reclotting of the artery; sometimes it simply
cannot be corrected. There can be bleeding, heart
problems, infection, and even gangrene of tissue.
At Home After Surgery
- Continue with the
program started while you were in the hospital. You may
walk about as you wish, even climb stairs, but don't
- You may eat as you
did before the operation.
- You may shower if
you wish, with any dressings on or off.
- There may be narrow
strips of tape across the incision. It's all right if
they get wet; they will be removed in the doctor's
- After you dry
yourself, replace any dressings with clean, dry ones.
- It is important to
remember not to cross your legs and not to sit for long
periods. These positions tend to reduce the flow of
blood through the arteries and encourage clot formation.
Also, your feet and lower legs can swell and become
- Driving your car may
be important to you, but when you can do this safely
depends on the operation you had, the medicines you are
taking, and your condition in general. During the
follow-up visit, we will talk about when you can resume
driving and return to work.
- You may resume
sexual activity whenever you choose.
Call our office if...
- You develop
increasing pain in the toes or foot, they have changed
color, or you cannot move them.
- The incisions become
red or swollen, or there is drainage from them.
- You develop a
temperature higher than 100.7°F.
- You have any