ABC of Vascular Disease

Arterial Bypass

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An arterial bypass operation is done to treat a blockage in a major artery that is causing symptoms due to lack of sufficient blood flow.  A bypass operation involves using a bypass graft to carry blood from the normal artery above the blockage to an unblocked artery downstream of the blockage.  It is easier and safer to do this than to remove and replace the blocked artery.  Most bypass operations are performed for blocked arteries to the legs.

The name given to an arterial bypass operation in the tummy and leg is based on the names of the arteries that the bypass graft is attached to

bulletAorta - the main artery in the tummy
bulletIliac arteries - are the main artery in the pelvis, one on the right and one on the left
bulletFemoral arteries - the main arteries in the groin and thigh
bulletPopliteal arteries - the main arteries behind the knee and in the upper calf
bulletDistal arteries - the three major branches that supply blood to the lower calf and foot

So, a bypass graft that goes from the groin to just blow the knee is called a femoro-popliteal bypass.

The ideal choice of material for a bypass graft is actually normal artery but this is not available.  The next best is the vein from the leg that runs just under the skin.  This is best for bypass operations that go into the upper and lower calf.  For the larger arteries in the tummy and pelvis, the best graft is a man-made graft made from plastic.

In order to do an arterial bypass operation safely it is necessary to expose and control the arteries where the bypass graft will be connected.  Incisions are made at the appropriate points and the arteries exposed.  The bypass graft is then prepared and the patient is given drugs to prevent the blood clotting in the new graft.  The arteries are then clamped to prevent bleeding, a small opening made in the artery and the open ends of the bypass graft stitched to the arteries.  Once this is done, the clamps can be removed and the blood allowed to flow through the graft and around the blocked artery.  The incisions are then closed to prevent infection and the patient is monitored closely to ensure that no complications occur.

Sometimes problems occur with the new bypass graft, such as bleeding from the junctions or a blockage in the graft caused by a blood clot.  If one of these complications occurs it may require further surgery to correct.

Recovery from an arterial bypass operation is quite rapid because the patient can usually eat an d drink normally and after just a few days can start to walk about.  Full recovery takes several weeks but it is not usually necessary to stay in hospital for that long.  Careful monitoring of the graft is important in the first few months to ensure that no delayed complications occur.

An arterial bypass is never as good as a normal artery and the bypass graft should be looked after.  Redo bypass surgery is more difficult, more dangerous and has a poorer success rate.  The best way to look after a new bypass graft is to give up or treat all the things that furred up the original artery .... i.e. smoking, high blood cholesterol and diabetes.

Arterial bypass operations are major procedures that carry a degree of risk and so should only be undertaken if there is good justification; however they offer excellent relief from severe symptoms and provided the graft is looked after, the benefits can last for many years.

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S.R.Dodds 2001

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