Artery Bypass To The Legs

General Information

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 popliteal arteries. 

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 supply, occurs.

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.

Treatment

Many patients can be treated medically. This includes the following things:

• Stop smoking.
• Taking off excess weight.
• Starting an exercise program.
• 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 failure.

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.

The Operation

• You will be given either general anesthesia, or a spinal, whichever is appropriate.
• 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 body.
• 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.

Following Surgery 

• You will be taken to a recovery room. When your blood pressure, pulse, and breathing are stable, you will be taken to a regular hospital room.
• 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 overdo things.
• 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 office.
• 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 uncomfortable.
• 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 questions.