Artery bypass surgery
What is artery bypass surgery?
Artery bypass surgery is a surgical procedure in which we create an alternative pathway for blood flow to reroute your blood supply around a blocked artery. Blocked arteries in the legs can restrict blood flow, causing pain, numbness and even gangrene. Individuals who suffer from diabetes, have a history of smoking, are affected by high cholesterol, have a problem with lipid metabolism or who are hypertensive are at risk for arterial blockages.
Why it's done
The primary reason we perform this procedure is to salvage limbs that would otherwise be lost without surgical intervention. Often, we find this treatment is the best solution for patients who suffer from peripheral arterial disease (PAD) and have developed critical limb ischemia (CLI), as well as those who have developed, or are at high risk for developing gangrene.
Research at Northwell
Currently, we’re taking part in a National Institutes of Health study to explore the success of bypass surgery versus the less-invasive endovascular treatment, specifically for patients with peripheral artery disease (PAD) who have developed critical limb ischemia (CLI), a severe blockage in arteries in the legs or feet. This is just one example of our continual efforts to offer you the highest, most effective level of care.
The success of an artery bypass surgery ultimately depends on the vein or graft being used to channel blood flow. If a vein was harvested for a different procedure, an alternative might need to be used. Similarly, if the veins surrounding the bypass site aren’t strong enough, the bypass’s durability will be affected. Even if the vein or graft used and the veins surrounding it are equally strong, the longevity of this procedure is typically short-lived. The five-year success rate of bypasses above the knee vessels is roughly 80 percent, while the rate for bypasses to smaller distal targets is approximately 50 percent.
It’s important for patients with critical limb ischemia to understand that the success of this procedure goes far beyond how long the conduit lasts, as circumventing limb loss is our top priority. In these instances, a bypass is usually necessary to get a wound to heal. Once the wound heals, so long as no additional trauma occurs, your limb may be salvaged, even if the bypass closes. Therefore, in these particular cases, limb salvage rates are a far better indicator of a successful procedure than the bypass’s lifespan.
Risks associated with this procedure are different for every patient. Possible risks include infection and hematomas, a collection of blood in the soft tissues. If you have extensive gangrene, it’s important for you to be aware that limb loss is a possibility—but an outcome that we will work diligently to avoid. In addition, if you suffer from certain atherosclerotic blockages in the leg, there is chance you could have blockages affecting arteries in your heart. That’s why we work closely with cardiologists to confirm your heart is strong enough for surgery beforehand, performing everything from stress tests, an echocardiogram and even cardiac catheterizations.
The most common complications are infection and bleeding under the surface of the skin. To reduce the risk of infection, our specialists make it a point to perform several physical examinations and tests to address any ongoing infections prior to the surgical bypass.
What to expect
The procedure will require you to be put under general or regional anesthesia. Once you’re under, we’ll make a small incision in the blocked artery. Then, we’ll sew either an accessory vein we harvested or a synthetic graft around the blocked artery, which will create a new passage for blood to flow through. The procedure typically takes a few hours.
How to prepare
You should be aware that we may have to make several incisions to harvest veins leading up to the procedure. Additionally, your vascular surgeon will place an emphasis on controlling your sugar, hemoglobin A1C's levels before surgery. We will work with you every step of the way to ensure you’re fully prepared for a seamless, successful procedure.
After the surgery, you can expect to be hospitalized for approximately four days. Some bruising, swelling, drainage and minor discomfort during this time is likely.
Certain patients may need to undergo rehabilitation following the surgery, particularly those who are elderly. You may require co-amputations following the surgery. We work in conjunction with other physicians, such as a podiatrist, to coordinate such efforts.
Our commitment to your care doesn’t stop when your wound is healed. We’re dedicated to continuing or improving your quality of life for the rest of your life. We’ll map out a plan for consistent follow-up visits, during which we’ll use ultrasounds to detect any abnormalities within the graft. This allows us to intervene if defects occur before the graft actually fails. There may be future procedures required to fine-tune and prolong the grafts.