lower extremity bypass
Lower extremity bypass is a minimally-invasive procedure performed to enhance blood flow to the thigh, calf, or foot in an effort to improve walking or alleviate pain.

The goal of lower limb or extremity bypass surgery is to enhance blood flow to the thigh, calf, or foot. This procedure may be required to improve walking, alleviate pain, or heal ulcers or other lesions due to poor blood circulation in the lower extremities.

2 categories of lower extremity bypass

Patients who have this bypass surgery usually fall into one of two categories:

The first category

  • Patients who have intermittent claudication or pain, commonly in the calf muscle, after walking a specific distance.
  • This discomfort comes as a result of a blockage or narrowing of the arteries, which restricts blood supply to the muscles.
  • These patients are unlikely to lose their limb without surgery, but with a successful bypass, the blood supply to the working muscles is enhanced, and patients are often able to walk much further.

The second category

  • Patients undergoing this procedure have substantially reduced blood flow to their legs, resulting in ulcers or tiny patches of gangrene.
  • Chronic pain, mainly in the foot, is a common symptom.
  • In this case, a successful bypass could be the difference between saving or losing a limb.

How is lower extremity bypass performed?

Typically, the surgery is carried out under general or epidural anesthesia. The procedure is intended to enable blood flow that bypasses the occlusion via a vein or a plastic graft.

  • Before surgery, the blood flow will be evaluated using Duplex scans and a dye test to determine the ideal location for the graft to begin and stop.
  • The graft will usually go from the groin to around the knee, although it may run just above the groin or down to the calf or foot. The surgeon should go through all the specifics of your procedure with you.
  • You may undergo a scan to see whether the vein in your leg is suitable for use as a graft. However, if it has previously been removed, is too small, or is not functioning properly, a plastic graft may be required.
  • Cuts will be made in the leg above the groin and along the inside of the knee. The graft (autogenous or synthetic) is attached. At the end of the procedure, the incisions will be closed with stitches or clips.

On day two, you should be sitting up and after about four days, you should be walking to the restroom. Most people expect to return home in about seven days.

What are the possible risks of lower extremity bypass?

As with every procedure, some risks will be involved.

Patients with advanced peripheral artery disease have a high frequency of significant heart disease, so a thorough evaluation for cardiac problems and a careful review of medical therapies are required before surgery.

Lower extremity bypass surgery has common risks, which may include:

  • Side effects of anesthesia
  • Bleeding
  • Graft failure
  • Infection
  • Numbness
  • Heart attacks
  • Blood clots
  • Discomfort in the leg as incisions heal
  • Wound healing problems
  • A small number of individuals experience severe scarring at the graft, which can result in substantial narrowing again

The side effects are rare; however, the symptoms you had preoperatively should be improved immediately.

Patients may need regular six months checkups to identify any complications. Patients will need to be on blood thinners forever and should never smoke again. Both measures are important to prevent the graft from blocking off.

SLIDESHOW

Spider & Varicose Veins: Causes, Before and After Treatment Images See Slideshow

What is the outcome of lower extremity bypass?

Overall, 90 to 95 percent of bypass surgeries are initially successful.

The material used for the bypass graft itself, as well as the quality of the arteries in the lower leg to which the graft is joined, are most directly associated with the procedure's short and long-term success.

  • The best results are obtained by doing these grafts on a patient's vein, most commonly the saphenous vein from the inside of the leg.
  • When a suitable saphenous vein of adequate length is not available, surgeons may utilize other veins from the arm or leg or an artificial (prosthetic) graft. However, these alternatives may have a lower success rate.
  • As a result, whether a good vein is likely to be available to execute the bypass is a significant consideration while selecting this treatment for a patient.
  • After surgery, smoking cessation and ongoing medical care, including aspirin and cholesterol-lowering medications, are crucial.
  • Patients who have had successful bypass surgery should expect pain alleviation, improved healing of foot sores, increased walking capacity, and long-term freedom from amputation if the graft continues to work.

Lower extremity bypass surgery is the most effective and long-lasting therapy now available for many patients with severe peripheral arterial disease.

Health Solutions From Our Sponsors

Medically Reviewed on 4/12/2022
References
Image Source: iStock Image

The MetroHealth System. Lower Extremity Bypass. https://www.metrohealth.org/vascular-surgery/treatments/lower-extremity-bypass

The Ottawa Hospital Foundation. What Is Leg Bypass Surgery? https://ohfoundation.ca/leg-bypass-surgery/

The Cochrane Collaboration. Bypass surgery for chronic lower limb ischemia. https://www.cochrane.org/CD002000/PVD_bypass-surgery-chronic-lower-limb-ischaemia