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This procedure is more or less of the same magnitude as abdominal aortic aneurysm repair. Aorto-femoral bypass surgery is usually carried out in patients with extensive occlusion of their iliac arteries. At its lower end, the aorta divides into two iliac arteries, one to each side of the pelvis and the corresponding leg. The majority of iliac artery disease is amenable to angioplasty with or without stenting. In those patients who are not suitable for angioplasty, surgery is performed to create a bypass from the aorta to the arteries in the groin (femoral arteries). As with all the other procedures, once anaesthetised, preparation for surgery will continue by creating a sterile field for the operation. The procedure will then begin, with incisions in the abdomen as well as both groins. The incisions may be vertical or oblique. After exposing the aorta, heparin is given to stop the blood from clotting, and a special clamp is applied to the aorta above the level of the bypass. A 2-3 cm opening in the aorta is made and a bifurcated Dacron graft is sutured to this opening. The two limbs of the graft are then tunnelled deep in the pelvis and to the groins. The distal ends of the grafts are sutured to the respective femoral arteries. After completing the graft suturing, the clamps are removed and the blood is allowed to the legs through the new graft. All the wounds are then closed. The average operation time is two hours. Following completion of surgery, you will be gradually woken up. At this stage you may start remembering events that surround you. You will feel quite uncomfortable especially if you are still breathing through a tube. You should not, however, be in severe pain.
From theatre, you will be transferred either to the high dependency unit or the intensive care unit. Your stay in these units will depend largely on the complexity of your operation and your speed of recovery. A different team of anaesthetists, nurses and physiotherapists will now look after you. Your family can visit you at this stage, but you may not be able to properly communicate with them due to the various medications you will be under. Over the following few days, you will return to your original ward and will be gradually allowed to drink and eat. Most of the lines and tubes will be out by now. If all goes well, you will be allowed to go home 7 to 10 days postoperatively. For the few weeks following surgery, you will feel rather weak and less energetic than usual. This feeling gradually disappears.
Aorto-femoral bypass grafting is a major procedure which is associated with a number of potentially serious complications. The most significant of these complications is mortality. The main cause of death from these procedures is heart problems. It is therefore important to note that your heart's pre-operative state of health determines to a great extent your chances of a quick and full recovery. Transient major organ dysfunction such as respiratory or renal failure may follow this type of surgery. However, as the haemodynamic changes associated with this procedure are less than those encountered with aneurysm surgery, the incidence of such complications is less. Smoking, diabetes, hypertension and pre-existing renal impairment increase the risk of such complications. Although you will receive antibiotics during surgery, infection remains a risk. The commonest form is wound infection. This will affect approximately 3-5% of patients. Less commonly, the inserted graft may become infected. This is a serious complication that affects approximately 1.9% of patients. A second procedure may be required to remove the infected graft. Other possible complications related to this procedure include limb ischaemia, bowel ischaemia and retrograde ejaculation.
Admission: Day before surgery Anaesthetic: General-Epidural Stay in hospital: 7-10 days Removal of sutures: 10-14 days Time off work: 4-6 weeks First follow-up appointment: 6 weeks |
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