Problem: Peripheral Artery Disease (PAD)
Peripheral artery disease occurs when the arteries in the leg can’t bring enough blood to the leg and foot muscles. PAD causes pain and cramping in the legs after walking even short distances. This leg pain is called claudication. Cramping and pain can also occur with sitting and is known as rest pain.
Normally, arteries carry oxygen-rich blood throughout the body and veins return blood to the heart. The arteries have open, smooth interiors that allow blood to flow smoothly. Artery walls can become damaged with time by factors such as smoking, environmental stress, and diabetes. Cholesterol and other blood components can stick to the damaged arterial walls, forming plaque. Plaque can build up, making the artery walls even rougher. This buildup of plaque and hardening of the arteries is known as atherosclerosis. Initially the artery provides enough blood for the muscle during rest, but eventually the artery can become completely blocked by plaque or a stuck blood clot. If small arteries branch around the blockage, some blood will reach the muscle. If these small arteries do not develop, the tissue below the blockage will not get any blood and will eventually die (gangrene).
Treatment: Surgical Bypass
If you are experiencing signs and symptoms of PAD, Dr. Robbins will probably order an ultrasound of your legs to check for blockage. This ultrasound will show any blockage that is present, where it is, and how severe it is. Another test that Dr. Robbins may order is an arteriogram. An arteriogram is done by injecting contrast fluid into the affected artery to take x-ray images of the artery. If these tests show that the blockage is severe enough, Dr. Robbins may suggest a bypass. A bypass creates a new path for blood flow around the blockage, letting more blood get to the leg and foot.
During surgery, Dr. Robbins will attach a graft, which is a special tube, to the blocked artery. The graft can be manmade or a blood vessel from your body. It reroutes blood flow around the blockage. The type of graft used depends on the location of the blockage and condition of your leg veins.
Blockage can occur in almost any artery, but there are some areas that are more commonly blocked that require a bypass. Two common types of bypass are a femoral popliteal bypass and a distal bypass. A femoral popliteal bypass is needed when the femoral artery of the upper leg is blocked. A graft, either synthetic or one of your leg veins, reroutes blood around the blockage in the femoral artery to the popliteal artery behind the knee. A distal bypass is needed when the blockage is lower down the leg or near the knee. The graft, again either your vein or a synthetic one, attaches to the artery above the blockage and reroutes the blood to an open artery further down the leg.
Surgery: What to Expect
Whatever type of bypass you are having, Dr. Robbins and the PA closely watch and monitor your status during surgery. You will most likely be asleep during the surgery with general anesthesia, but sometimes local anesthesia is used. Incisions in both your skin and the blocked artery will be made to prepare and attach the graft. After the graft is stitched in place, Dr. Robbins checks the bypass and connections for any problems. Once he is satisfied, Dr. Robbins closes the incisions with stitches.
Preparing for Your Procedure
You will be told by our office how to prepare for your procedure. This includes special instructions about medications. Be sure to follow the instructions we give you, or your surgery may have to be canceled.
A Week Before
- Tell us about any allergies you have.
- Tell us about any medications you take, including prescriptions, over-the-counter medications, supplements, and herbs.
- Make medication changes as we direct you. This can involve stopping certain medications you normally take or starting certain medications before surgery.
The Day Before
- Don’t drink or eat after midnight the night before you surgery. Do not smoke, chew tobacco, or chew gum after midnight. If you were instructed to continue any medications, take them with a sip of water only.
- Arrange a ride home for when your recovery is finished.
- Follow any special instructions we give you.
The Day of the Procedure
- Arrive on time to the hospital.
- Bring all medications you take with you to the hospital.
- Hospital staff will prepare you for the procedure.
After your procedure, you will probably stay in the hospital from 2 to 7 days. Once you return home, your recovery should take about 1 to 4 weeks. Be sure to schedule a follow-up with our office two weeks after your surgery. Here are some guidelines to follow during your recovery:
- Keep the incision or puncture site clean and dry.
- Take medications as prescribed.
- Do not drive until cleared to do so.
- Avoid lifting objects more than 10 pounds for at least a week or otherwise instructed.
- Walk regularly. This improves recovery.
Surgical bypass does not prevent the buildup of more plaque. Some lifestyle changes can greatly influence and preserve the success of your bypass graft. Some beneficial lifestyle changes include:
- Quit smoking
- Eat foods low in fat, cholesterol, and calories
- Reduce blood pressure
- Control blood lipid levels
- Exercise (20-30 minutes at least 5 times a week)
When to Call VascularTyler
Call our office if you experience any of the following symptoms:
- Drainage from your incision, or if it becomes red, hot, or painful
- An increase in pain
- Swelling of your leg that does not improve overnight
- Changes in color, feeling, or temperature of foot