Lower limb arterial occlusion – bypass grafting

Introduction

The inner walls of healthy lower limb arteries are smooth, allowing blood to flow freely. However, as we age, coupled with unhealthy diets and lifestyles, cholesterol and other substances build up on the inner walls of arteries, causing them to become narrowed and less smooth, a condition known as atherosclerosis. In severe cases, this can lead to arterial occlusion, obstructing blood flow. This deprives the tissues in the lower limbs of necessary nutrients and oxygen, resulting in pain, and potentially tissue necrosis. Bypass surgery can improve blood circulation.

Surgical procedure

This surgery is performed under regional or general anaesthesia. The doctor will use a suitable vein from your body or an artificial graft to bypass the blocked artery, routing blood to the more distal part of your limb. The inserted vein/graft will remain in your body permanently. You will need to stay in hospital for approximately one week.

Surgical risks or complications

1. The estimated mortality rate attributable to the operation is less than 5%
2. Systemic complications
3. Cardiovascular complications: myocardial infarction, arrhythmia, congestive heart failure
4. Respiratory complications: pneumonia, respiratory failure
5. Kidney failure
6. Other: Stroke, Deep vein thrombosis, Pulmonary embolism
7. Localised complications
8. Graft: Infection, Embolism
9. Haemorrhage, pseudoaneurysm
10. Lower limb major artery ischaemia
11. Wound infection or poor healing
12. Damage to the peripheral nerves, causing numbness or pain in the feet.

Pre-operative preparation

1. For elective surgery, you'll usually be admitted to hospital the day before to undergo pre-operative checks, including blood tests, X-rays or an ECG.
2. The doctor will explain the procedure to you and your family in detail, and you will need to sign a consent form.
3. Before your operation, a healthcare professional/vascular diagnostic technician will mark the site of your affected limb where the surgery will take place. Nurses may also apply a local anaesthetic to your affected limb.
4. The night before your operation, you will need to take a bath and wash your hair. Nursing staff will assist you by shaving any hair from your groin, pubic area and affected limb.
5. You will need to stop eating and drinking approximately 6 hours before your surgery. The nursing staff will inform you of the time you need to stop eating and drinking.
6. Before going into the operating theatre, you must change into a surgical gown, put on a surgical cap, and wear surgical socks (remove your own clothing, including underwear, dentures and accessories).
7. You may need to have an intravenous drip (saline drip), and to take or receive injections of pre-operative medication.

Post-operative instructions
Post-operative general condition

1. If you have had a general anaesthetic, you may feel tired, weak, or dizzy; these are post-anaesthetic symptoms which will gradually wear off.
2. After a general anaesthetic, you may experience throat discomfort or phlegm. You should follow instructions to take deep breaths and practise coughing to help reduce the risk of lung infection.
3. Healthcare professionals will regularly measure your blood pressure, pulse and check your wounds.

Activity

1. You must rest in bed for the first 12 hours after the operation, and light activity in bed is permitted.
2. Twelve hours after surgery, you may get out of bed to sit or walk. Getting up and moving around as soon as possible will help you recover quickly, but you should gradually increase your activity each day as guided by your healthcare provider.
3. For the first two to three weeks after surgery, you should avoid strenuous exercise and lifting heavy objects as much as possible.
4. Full recovery depends on individual circumstances and may take varying amounts of time.

Wound dressing

1. After your operation, your wound has been covered with a sterile dressing and tape. There may be 1-2 suction drains attached to the wound to remove wound fluid. Please remember to keep the wound dressing clean and dry, and to ensure the drains are clear. If you notice any bleeding from the wound, please inform the medical staff immediately.
2. If the wound is painful, please inform the medical staff.
3. When active, avoid pulling on the drainage tube. The drainage tube will be removed 1-2 days after surgery.
4. The stitches on the wound will be removed approximately 7-10 days after surgery.

Food and drink

1. The doctor will assess your condition after surgery, and you will gradually return to a normal diet.
2. Except for patients with kidney disease, diabetes, and the like who need to diet, general patients can eat a normal diet.

Post-discharge instructions

1. The following measures must be continuously taken to control atherosclerosis:
2. Stop smoking.
3. Pay attention to a balanced diet; avoid foods high in salt, fat, and sugar.
4. Control blood pressure, blood sugar, and cholesterol with medication prescribed by a doctor.
5. Foot care: Take good care of your feet.
6. Exercise therapy: Daily walking exercise therapy.
7. Medical Treatment: Take antiplatelet medication (e.g., aspirin) as prescribed by your doctor.
8. Please attend the hospital for your follow-up appointment and ultrasound scan on the specified date and time.

Notes

This leaflet provides only basic information about the surgery, and not all possible risks or complications can be listed. The risk level also varies for different types of patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/vascularsurg_bypassforatheroscleroticocclusivediseaseofthelowerextremities_0173_chi.pdf