Learn about the best ways to treat aortic stenosis with aortic bypass surgery performed by the most skilled cardiovascular surgeons in Turkey.
Definition of Aortic Bypass Surgery
Artificial tubes (grafts) are placed near a section of a blocked or narrowed blood vessel. They create a pathway so that blood can move around the blockage. In this case, the grafts are placed along the course of the aorta and the iliac or femoral artery.
The aorta is the main artery that leaves the heart. It brings oxygen-rich blood to the body. At about the level of the navel, the aorta divides into two iliac arteries. At the level of the groin, the iliac arteries become the femoral arteries.
Aorto-femoral bypass surgery is also known as an aortic anastomosis. This is because it is an inverted “y” shape.
Most bypass surgeries involve a traditional open incision. Research is being done on how to perform these operations through laparoscopic or minilaparotomy techniques. Much smaller incisions are used.
Reasons for aortic bypass surgery
To get good blood flow to the lower body, there must be good blood flow through the aorta, iliac arteries, and femoral arteries. Atherosclerosis is a disease in which sticky patches (plaques) build up along the walls of blood vessels. These plaques block the normal flow of blood within the affected blood vessels. When blood flow is reduced, tissues on the other side of the blockage don’t receive enough oxygen. This can lead to:
- Pain that increases the longer you walk or exercise (called intermittent claudication)
- Cold feet or legs
- Flaky, dry, red, itchy, brown skin on the legs or feet
- Unhealed and/or infected sores on your legs or feet
- gangrene
- Need to amputate the leg
- nerve damage
Aortic bypass surgery can restore blood flow to the legs
Possible complications of aortic bypass surgery
Problems from this procedure are rare, but all procedures carry some risk. Your doctor will review potential issues, such as:
- Infection
- New bypass blockage by blood clots
- Bleeding
- Complications of anesthesia
- Scarring
- nerve damage
Before the procedure, talk to your doctor about ways to manage factors that may increase the risk of complications, such as:
- Smoking
- Alcohol
- Chronic diseases such as diabetes or obesity
Types of Aortic Bypass Surgery
Femoral arterial bypass surgery is the best option for blockages that restrict blood flow to the femoral artery. However, there is another procedure called axillary femoral bypass that can be used in some cases of cardiac bypass surgery.
Axillary femoral bypass puts less pressure on the heart during cardiothoracic surgery. It also doesn’t require opening your abdomen during aortic bypass surgery. This is because it uses a plastic tube graft called an aortic bypass graft that connects the femoral arteries in your legs to the axillary artery in your shoulder. However, the surgery used in this procedure has a higher risk of blockage, infection, and other complications because it travels a greater distance and because the axillary artery isn’t as large as the aorta. The increased risk of complications is because the graft isn’t deeply buried in the tissue and because the bypass is narrower in this procedure.
What to expect when arranging for aortic bypass surgery
Before the procedure, your doctor may do the following:
- Clinical examination
- Blood tests
- Ankle-Brachial Index – This test compares blood pressure measurements in your arms and legs. These numbers should be very similar. If the values in your legs are significantly lower than those in your arms, this indicates a blockage in the arteries that carry blood through your legs.
- Doppler ultrasound – This test uses sound waves to examine blood flow in the arteries. It can identify blocked arteries.
- Angiography – A dye is injected into your arteries, and X-ray images of your legs are taken. Since the dye won’t be able to flow through areas that are narrowed or blocked by plaques, the exact location of the blockages will be determined. Other types of minimally invasive angiography currently in use also include computerized tomography angiography and magnetic resonance angiography.
Before aortic bypass surgery:
- Don’t eat or drink anything after midnight the night before bypass surgery.
- Arrange for help at home after you return from the hospital.
- Arrange to have someone drive you home when you leave the hospital.
Talk to your doctor about your medications. You may be asked to stop taking certain medications for up to a week before the procedure.
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Aortic bypass surgery description
A large incision will be made in your abdomen. The muscles around your abdomen will be cut. To access the abdominal aorta, some organs must be carefully moved out of the way.
Blood flow through the vessels will be briefly stopped. Clips will be placed on either side of the blocked area to stop the blood flow. The bypass will be sutured in place. The coronary artery will be bypassed by attaching one end to the aorta just above the blockage. The other end will be tied directly after the blockage to the femoral or iliac arteries.
The clips will be removed. The doctor will monitor to make sure there is good blood flow through the bypass. Your internal organs will go back into place. Your abdominal muscles will be pulled together. The muscles will be stitched closed. The skin incision will be closed with either sutures or staples.
After aortic bypass surgery
After surgery, you will be taken to a recovery room. The tube in your throat may be removed, or it may need to stay in for a few days. Epidural anesthesia may also last for a few days. You’ll be monitored for any adverse reactions to the surgery or anesthesia.
How much will it hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be controlled with medication.
Average hospital stay
The usual length of stay is 5-7 days. The length will depend on your overall health and the speed of your recovery. Your doctor may choose to keep you longer if complications arise.
Post-aortic bypass surgery care
In the hospital
You will need to spend a day or two in bed after the procedure.
- You will be carefully monitored in the Intensive Care Unit (ICU). You may be there for a day or two as needed.
- A stimulation spirometer, which you will use every two hours during the day. This will keep your lungs as open as possible and help avoid pneumonia.
- A nasogastric (NG) tube may be placed during the procedure. The tube is placed through your nose and into your stomach. Your bowel often stops working normally after surgery. You won’t be able to eat anything by mouth until it starts working again. The NG tube will then be removed. You will slowly progress from a liquid diet to a soft food diet and finally to a regular diet.
- You may also be given daily medications to help prevent blood clots.
During your stay, cardiac surgery hospital staff will take steps to minimize the chance of infection, such as:
- Wash their hands
- Wearing gloves or masks
- Keeping surgical wounds covered with a bandage
There are also steps you can take to minimize your chances of infection, such as:
- Wash your hands frequently and remind visitors and caregivers to do the same
- Remind caregivers to wear gloves or masks
- Not allowing others to touch the wound
At home
Recovery may take up to 6 weeks. You can expect to see a significant improvement in your overall ability to walk or exercise. When you go home, you’ll need to keep the wound clean to prevent infection. Pain can be controlled with medication. You may be referred to a physical therapist to maintain or rebuild your strength.
What to expect after aortic bypass surgery
Eighty percent of aorto-femoral bypass surgeries successfully open the artery and relieve symptoms for 10 years after the procedure. Your pain should be relieved when you are resting. The pain should also disappear or be significantly reduced when you walk. Your prognosis will be better if you don’t smoke or quit smoking before your aortic bypass graft surgery.
The importance of communicating with your doctor after aortic bypass surgery.
It’s important to monitor your recovery. Alert your doctor to any issues. If any of the following happen, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increased pain, excessive bleeding, or any discharge from the wound site
- Persistent nausea or vomiting
- Pain that you can’t control with the medications you’ve been given
- Pain, burning, urgency, frequent urination, or persistent bleeding
- Cough, shortness of breath, or chest pain
- Your leg becomes cold, pale, blue, tingling, or numb
- Pain or swelling in your legs, calves, or feet
If you think you have an emergency, call emergency medical services immediately.
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