If the above procedures are recommended to you, you have been diagnosed with peripheral arterial disease (PAD) and you have significant narrowing of the circulation to the legs in the main arteries of your abdomen.
In the legs, the most common symptoms are muscle aches and pains associated with an exercise called claudication, which calm down at rest. However, some patients may experience a constant icy burning pain in their feet called resting pain. In the most severe cases, patients may develop skin ulcers or black toes due to restricted blood flow. After a dye test (arteriogram) to show the extent of the disease, an operation to improve blood flow to the legs may be appropriate.
What operation will be performed?
Aortobifemoral bypass
This is the best surgery as it will restore the normal anatomy of your aorta and femoral arteries. A tube of fabric in the form of
Aortobifemoral bypass
The pants are sewn into the existing blood vessels and bypass the blockages known as aortobifemoral grafts.
This involves making an incision in the abdomen to reach the aorta and also in the groin to reach the femoral arteries. The graft is then sewn into the arteries to connect them and restore blood flow to the legs.
This surgery is not compatible for all patients. Before surgery, you need to undergo preoperative tests. If the results of these tests suggest that you are at particularly high risk, either from anesthesia for lung problems or surgery for heart problems, an alternative surgery known as axillo-bifemoral bypass may be considered.
Axillobifemoral bypass
This surgery connects your axillary artery in your shoulder to your femoral arteries in your legs using flexible plastic tubing called a graft. This will restore the blood supply to your legs.
This surgery puts less stress on the heart because it avoids opening the abdomen. However, the graft is more prone to complications like blockages and infections because it is narrower and not well buried in the tissue.
Your surgeon should be able to discuss the surgical risks in your particular case. You should discuss it with your family, friends, and your family doctor. We recommend bringing someone to the clinic and having a list of questions ready as people often forget some of their fears.
The operation
Before going to the hospital, you should consult your GP and counselor about the medications you are currently taking as you may need to stop them before surgery. You will have either an aortobifemoral or axillobifemoral bypass as described above. These procedures can be performed under regional or general anesthesia. It is very likely that you will need to be euthanized. Your anesthetist and surgeon will be able to provide further advice on this.
Recovery and aftercare
Generally, you will be sent back to the high dependency unit overnight, where you will be monitored to make sure everything is okay. You will be given something to eat and drink after the operation and will likely return to the ward the next day.
You have a tube in your bladder for about a day until you are mobile. You can expect to be able to go home about a week after the operation.
Risks and Complications
As with any major surgery, there are risks associated with the anesthetic and the surgery itself.
These surgeries will put a lot of strain on the heart, and most patients will do some type of heart test before surgery to make sure the heart is strong enough. As a result, the most serious complication is heart attack, part of which will be fatal. The total mortality after surgery is around 3%, but it can vary greatly depending on preoperative fitness. Your surgeon should be able to provide you with a better personal risk, as well as a better local mortality rate, for this surgery.
Other less serious complications may occur, such as: kidney strain, chest or wound infection, postoperative bleeding, deep vein thrombosis, or transplant thrombosis, which can ultimately lead to loss of the leg.
The graft can rarely become infected or blocked, which may require lengthy antibiotics or further surgery.
Younger men should discuss with their surgeon the potential impact of the surgery on their sex life.
These complications can extend your hospital stay, but they shouldn’t have any long-term effects on your activities.