What is aortobifemoral bypass?
The aorta is a large artery that carries oxygen-rich blood from the heart to the various parts of the body. It divides into two iliac arteries at the region of the navel. These extend below the groin region to form the femoral arteries. Blood flows through the aorta, iliac arteries and the femoral arteries to supply oxygen to the lower parts of the body. In some cases, plaque or sticky substances such as cholesterol and calcium can build up on the inner wall of these arteries (atherosclerosis). Plaque deposition obstructs the flow of blood and decreases the oxygen supply to the tissues. This leads to a condition called peripheral artery disease (PAD). The condition can be treated surgically by a procedure called aortobifemoral bypass to restore the blood flow to your legs.
What are the indications for aortobifemoral bypass?
Aortobifemoral bypass is performed for atherosclerosis of the abdominal aorta or iliac arteries, and is indicated in cases of severe pain while walking (intermittent claudication), infected sores or ulcers on the extremities, gangrene, nerve damage, and need for amputation. Aortobifemoral bypass is recommended if you have multiple regions of blockage or a continuous, long obstruction in these arteries.
How do you prepare for aortobifemoral bypass?
Before the surgery, your doctor will conduct a physical examination, and order a blood test and imaging tests to determine the location and severity of the PAD. You may be advised to undergo angiography (contrast dye is injected through a thin tube and X-rays are taken) to identify blockages in your arteries. A CT angiogram may be used to provide a picture of the disease as well.
What can you expect during aortobifemoral bypass?
Aortobifemoral bypass is performed under general anesthesia. Sometimes, epidural anesthesia is also provided. During the surgery, your surgeon makes an incision in your abdomen and smaller incisions in both groins. The affected blood vessels are exposed and the blood flow is temporarily stopped by placing clamps. The graft, an artificial tube made into a “Y” configuration is generally used. The single end of the graft is sutured to the aorta above the blockage and the two split ends of the “Y” are sutured to the femoral arteries, beyond the blockage. The clamps are removed and the incision closed with sutures. The blood can now flow freely through the bypass, around the blocked region. The entire procedure can take 2-4 hours to complete. Its success is due to the experience of the surgeon. This case is one of those in surgery that greatly depends on the experience of the surgeon for success.
What do I expect after aortobifemoral bypass?
Common post-operative guidelines following aortobifemoral bypass include the following:
- You will be monitored in the recovery room for any adverse reactions after surgery
- Your doctor may continue with epidural anesthesia for a few days
- You may have to stay for 1-2 weeks in the hospital till you recover completely
- The first post-op night is generally spent in the ICU
- Most people’s bowels go to sleep after this procedure (ileus) for 1-30 days
- Call your doctor if you experience shortness of breath, chest pain, vomiting, cough, bleeding at the incision site, infection or swelling of legs
Are there any complications of aortobifemoral bypass?
Like all surgeries, aortobifemoral bypass procedure may be associated with certain risks such as, but not limited to:
- Heart attack
- Sexual dysfunction as a result of pelvic nerve damage
- Paralysis due to interruption of the blood supply to the spinal cord
- Damage to any organ in or around the abdomen
However, aortobifemoral bypass is considered a successful procedure to keep the artery open and alleviate symptoms and can last indefinitely.
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