Peripheral Bypass Surgery is performed to treat Peripheral arterial disease (PAD). The arteries that carry blood to your organs and muscles can become narrowed or blocked and cannot carry enough blood for proper functioning.

A bypass surgery is named for the artery that will be bypassed and the arteries that will receive the rerouted blood. The three common peripheral vascular bypass surgeries are:

A substitute vessel or graft must be used in bypass surgeries to reroute the blood. The graft may be a healthy segment of the patient's own saphenous vein (autogenous graft), a vein that runs the entire length of the thigh. A synthetic graft may be used if the patient's saphenous vein is not healthy or long enough, or if the vessel to be bypassed is a larger artery that cannot be replaced by a smaller vein.

Angioplasty or Bypass surgery is the treatment to this situation and would be decided on by the surgeon. The types of surgery used to treat PAD are categorized according to the location of the affected leg artery or arteries.

Common surgeries include:

• Aortobifemoral bypass, for narrowing of the aorta—the major abdominal artery—and the iliac arteries, which branch off from the aorta
• Femoropopliteal (fem-pop) bypass, for narrowing of the arteries in the thigh and knee
• Femoral-tibial bypass, for narrowing of the arteries in the lower leg or foot

Causes

• High levels of blood cholesterol and triglycerides
• High blood pressure (hypertension)
• Cigarette smoking or exposure to tobacco smoke
• Diabetes, types 1 and 2
• Obesity
• Inactivity, lack of exercise
• Family history of early cardiovascular disease

Symptoms

When narrowing of an artery occurs gradually, symptoms are not as severe as they are when sudden, complete blockage occurs. Sudden blockage does not allow time for collateral vessels to develop, and symptoms can be severe. Gradual blockage creates muscle aches and pain, cramping, and sensations of fatigue or numbness in the limbs; sudden blockage may cause severe pain, coldness, and numbness. At times, no pulse can be felt, a leg may become blue (cyanotic) from lack of oxygen, or paralysis may occur.

When the lower aorta, femoral artery, and common iliac arteries (all in the lower abdominal and groin areas) are blocked, gradual narrowing may produce cramping pain and numbness in the buttocks and thighs, and men may become impotent. Sudden blockage will cause both legs to become painful, pale, cold, and numb, with no pulse. The feet may become painful, infected, or even gangrenous when gradual or complete blockage limits or cuts off circulation. Feet may become purple or red, a condition called rubor that indicates severe narrowing. Pain in the feet or legs during rest is viewed as an indication for bypass surgery because circulation is reduced to a degree that threatens survival of the limb.

Diagnosis

After obtaining a detailed history and reviewing symptoms, the physician examines the legs and feet, and orders appropriate tests or procedures to evaluate the vascular system. Diagnostic tests and procedures may include:

• Blood pressure and pulses—pressure measurements are taken in the arms and legs. Pulses are measured in the arms, armpits, wrists, groin, ankles, and behind the knees to determine where blockages may exist, since no pulse is usually felt below a blockage
• Doppler ultrasonography—direct measurement of blood flow and rates of flow, sometimes performed in conjunction with stress testing (tests that incorporate an exercise component)
• Angiography—an x ray procedure that provides clear images of the affected arteries before surgery is performed
• Blood tests—routine tests such as cholesterol and glucose, as well as tests to help identify other causes of narrowed arteries, such as inflammation, thoracic outlet syndrome, high homocycteine levels, or Arteritis
• Spiral computed tomography (CT angiography) or magnetic resonance angiography (MRA)—less invasive forms of angiography

The bypass surgeries can be done with a vein or with a man-made (prosthetic) graft. But vein grafts can keep the blood vessel open longer than the man-made grafts.

Your specific surgical procedure depends on your symptoms, your overall physical condition, and how much plaque has built up in your arteries. Your surgeon, with the help of your anesthesiologist, may use either general or regional (epidural or spinal) anesthesia for the procedure.

For an arm or leg bypass, your vascular surgeon usually first selects and removes the vein that will serve as the bypass graft for your artery. The surgeon usually uses the Great Saphenous Vein (GSV) forPeripheral Bypass Surgery the graft, if it is suitable. Your GSV runs under your skin between your foot and your groin. Sometimes your surgeon may need to use another vein or a synthetic fabric artery for the graft. An incision is made over the skin to reach the bypass site in your blocked artery.

Once the artery is exposed the pulse in the healthy part of the artery is evaluated. By checking the pulse, your surgeon makes sure that the artery provides enough blood flow to supply the bypass.

The artery below the part that is blocked is opened where one end of the graft is connected. The graft is sewn into your artery with permanent stitches.

The other end of the graft is routed between your muscles and tendons to a site above the blockage. In the same way, the surgeon then opens the artery and, at this location, stitches the graft onto this end of the artery.

The bypass is checked for correct alignment and leakage. During the procedure, your vascular surgeon may perform an arteriogram or duplex ultrasound examination in the operating room to check the bypass for any problems. The incisions are closed when the surgery is complete.

After the procedure, your surgeon may order a duplex ultrasound or other non-invasive tests, such as pulse volume recordings, to make sure the bypass is functioning properly.

The hospital stay may range from about 3 to 10 days. After you leave the hospital, your surgeon will remove staples or stitches from the incisions, usually about 4 weeks after your operation.

The other major cardiac procedures are:

• Coronary Angioplasty
• Heart Valve replacement
• VSD (Ventricular Septal Defect Closures) Closures... etc

Few Major Hospitals for Peripheral Bypass Surgery are:

• Narayana Hrudalaya
• Apollo Hospitals
• Wockhardt Hospital
• Asian Heart Institute and research center
• Piyavate Hospital
• Florence Nightingale Hospital

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