Lower extremity bypass, also called peripheral vascular bypass, is a minimally invasive surgery that reroutes blood flow in the legs around a blocked artery. Like all surgical procedures, there are significant risks involved in lower extremity bypass.
11 risks of a lower extremity bypass
Risks of lower extremity bypass include the following:
- Bleeding or hematoma formation (collection of blood within the tissue layers)
- Wound dehiscence (separation or rupture of the incision that was sutured or stitched during the surgery)
- Graft failure
- Blood clots in the legs
- Leg swelling
- Nerve injury
- Heart attack
- Abnormal heart rhythm (arrhythmia)
- Kidney failure
- Sudden cardiac death
What happens during lower extremity bypass?
Before the procedure
- Your doctor will discuss the risks and benefits of the procedure.
- You will be asked about any underlying health conditions, allergies, or current medications you are taking.
- You may be told to stop taking certain medications before the procedure.
- You may be told to fast for a period of time before the procedure.
During the procedure
- Anesthesia may be administered intravenously
- Small incisions will be made on your leg depending on the site that needs to be bypassed.
- Your surgeon will use your vein (autogenous vascular graft) or a synthetic graft to bypass the affected artery by attaching the graft to the diseased artery.
- An imaging test called an angiogram may be used to ensure that the bypass is successful.
- Once confirmed, the surgical site will be closed and sutured.
- The procedure may take 1.5-6 hours to complete.
- You may need to stay in the hospital for a few days following the surgery.
Why is lower extremity bypass done?
The most common reason for performing lower extremity bypass surgery is peripheral arterial disease (PAD). Peripheral arterial diseases are caused by the narrowing of the arteries outside the heart, often resulting from the buildup of fatty deposits or plaque in the walls of the arteries (atherosclerosis). Although PAD can affect any blood vessel outside the heart, it mostly affects the blood vessels in the legs and arms.
PAD of the legs or lower extremity may compromise blood flow to the muscles and other tissues supplied by the blocked artery. This may result in symptoms such as:
- Cramping pain (also called intermittent claudication) especially while walking, running or going upstairs but may occur on rest as well
- Change in the color or texture of the skin of the affected leg
- Poor nail or hair growth of the affected lower extremity
- Poor wound healing over the affected site
- Dead tissue or gangrene formation
Lower extremity bypass surgery may be considered when these symptoms do not improve despite medications.
Other conditions for which a lower extremity bypass may be done include:
- Femoral or popliteal artery aneurysms (ballooning of an artery)
- Arterial thromboembolism (clotting) or dissection (tearing)
- Popliteal artery entrapment syndromes (a rare condition in which an enlarged or abnormally positioned calf muscle presses on the popliteal artery)
- Inflammatory arteritis (swelling in the walls of the arteries)
- Soft tissue sarcomas with vascular encasement (the tumor becomes inseparable from the blood vessel)
- Arterial injuries due to blunt or penetrating trauma
D'Ayala M, Eidt JF. Lower extremity surgical bypass techniques. UpToDate. https://www.uptodate.com/contents/lower-extremity-surgical-bypass-techniques
Lee CJ. Infrapopliteal Bypass Technique. Medscape. https://emedicine.medscape.com/article/1895511-technique
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