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Understanding Vascular Bypass Surgery

March 22, 2018

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Cardiology

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Most people are aware of heart diseases and the consequences one has to face because of the blockage in blood vessels and arteries.

However, what most people fail to realize is the fact that blockages which are caused due to the buildup of plaque as well as cholesterol tend to influence the functions of heart more than anything else. Arteries are responsible for carrying blood and oxygen to all parts of your body. The blockage can occur in any of the artery with grave consequences.

Vascular Bypass Surgery: Overview

The vascular bypass surgery involves methods related to endovascular surgeries which include the balloon angioplasty or stenting, thrombolysis, various adjuncts for vascular reconstruction and aortic & peripheral vascular endovascular stent or graft placement.

Human vascular system is formed by the wide network of blood vessels that circulate blood to and from your heart and lungs. Your circulatory system comprises of veins, heart, arteries, capillaries, and the circulating blood. The system is responsible for providing nourishment to your cells and discards their waste. The arteries transmit oxygen-rich blood from your heart to your cells. Once the blood reaches the cells, it is returned to lungs by the veins for the purpose of reoxygenation as well as recirculation by the heart. The aorta happens to be the largest artery that starts from the heart; which then subdivides into smaller arteries reaching out to every part of your body. As the arteries get narrow, they get connected to the smaller vessels known as the capillaries. The capillaries contain oxygen and nutrients as released from the circulated blood into the cells. And the cellular wastes are also collected. The capillaries then get connected to veins, which return the blood back to your heart.

The aorta starts from your heart, while arching upward; it then goes down through your chest (thorax) and abdomen. The iliac arteries branching out from the aorta, give blood to the pelvis as well as legs. The thoracic parts of the aorta give blood to your upper body, as it runs through your chest. The abdominal part of the aorta that supplies blood to your lower body continues through the abdomen.

Vascular diseases are normally caused due to conditions that result in clogging or weakening the blood vessels, or damaging valves that control blood flow in and out of your veins, which thus starves them of essential blood nutrients and oxygen. Some of the common diseases that affect your arteries include peripheral vascular disease (PVD), aortic aneurysms (AAA) and carotid artery disease.

The vascular bypass surgery helps in treating specific damaged arteries, like atherosclerosis, for preventing strokes or heart attacks, improving or relieving angina or hypertension, removing aneurysms, improving claudication, and saving legs that can get amputated.

Types of Vascular Bypass Surgery

Treating such blocked arteries and restoring the transmission of oxygen and blood is the vascular bypass surgery. Before we delve more into vascular bypass surgery, let us first understand the different vascular diseases that commonly occur.

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm (AAA) is characterized by the enlargement or “bulge” which usually develops in a depleted area or in the weakened area within the largest artery in the abdomen. As each artery generates a pressure, the weakened aortic wall is pushed. This results in the enlargement of the aneurysm. As the aorta happens to be body's major supplier of blood, a fissured abdominal aortic aneurysm can lead to lethal bleeding.

Based on the size as well as the rate at which the abdominal aortic aneurysm grows, the treatment mode will range from watchful monitoring to emergency surgery.

In most of the cases where abdominal aortic aneurysm is detected, the doctor will consider monitoring the condition closely so that the surgery can be determined as and when needed.

Emergency surgery for a fissured abdominal aortic aneurysm can prove to be very uncertain. In cases where the abdominal aortic aneurysm stands undetected, the aortic wall keeps on getting weak and the aneurysm keeps on progressing. Consequently, the aneurysm will become very large and its wall will turn so weak that the rupture will happen eventually. As the rupture occurs, you can experience massive internal bleeding, which in most cases proves to be a fatal condition. To prevent this situation, it is very important that the abdominal aortic aneurysm is identified before it actually ends up rupturing.

Carotid Artery Disease - Stroke

The carotid arteries found in the body happen to be the primary blood vessel that does the function of delivering the blood to your brain. On each side of your neck there is one carotid artery located. The doctor when checking the pulse in your neck actually detects the carotid artery. A carotid artery is known to be the primary cause of stroke. This disease usually occurs due to a blockage in one or both of the carotid arteries, which apparently cuts down the amount of blood that flows to your brain. This is the condition which leads to stroke. A carotid artery disease is usually caused because of atherosclerosis, which is a disease wherein the plaque builds up in your arteries. Even in the cases of coronary heart disease, a similar kind of buildup happens in the blood vessels of the heart. This plaque majorly contains of clumps of fat, cellular waste, cholesterol, protein as well as calcium. Atherosclerosis is even responsible for making the carotid arteries narrower, also lesser flexible gradually. Due to this, the amount of blood which flows to different organs also reduces. Carotid artery disease can even occur due to diseases that lead to arterial damage.

Peripheral Arterial Disease

Peripheral artery condition is defined as a circulatory problem wherein your narrowed arteries cutback the flow of blood to your limbs.

When you experience peripheral artery disease (PAD), your legs fail to get sufficient amount of blood flow for keeping up the required blood flow in the legs. This results in leg pain when you walk and is medically termed as claudication.

Sometimes, the peripheral artery disease can also occur because of the extensive amassing of fatty deposits in the arteries, known as atherosclerosis. This condition tends to reduce the flow of blood to the heart, brain and the legs.

Peripheral artery disease can successfully be treated if you can quit tobacco, form a regular exercise routine and eat a healthy diet. Some of the symptoms of claudication include pain in muscles or cramping in the legs and arms, often triggered by activities like walking. However, this cramp often goes way when your body is at rest. The location of pain will also depend on the location of the narrowed or clogged artery. Among the locations, calf pain is the most common one where you tend to experience pain and cramp.

The intensity of claudication ranges widely, from being mildly uncomfortable to crippling pain. In case of severe claudication, you can even find it difficult to walk or undertake any physical activity. Some of the commonly associated symptoms of peripheral artery disease include:

  • Painful cramping in thigh, hip, or calf muscles after you do some activities, like
  • Walking or climbing stairs
  • Sores on toes, feet or legs that don’t heal
  • Numbness or weakness in the legs
  • Erectile dysfunction in men
  • Coldness in the lower leg or foot
  • Change in kegs color
  • Hair loss
  • Slower hair growth on the feet and legs
  • Slower growth of toenails
  • Shiny skin on the legs
  • No pulse in the legs or feet

Types of Vascular Bypass Surgery

Depending upon the location of the blocked artery and the treatment mode needed, vascular bypass surgery has been classified into different types. Some of the commonly used vascular bypass surgery types include:

Endovascular repair of abdominal aortic aneurysms: This surgery type is mostly recommended in the cases where people are detected with the abdominal aortic aneurysm (AAA). In some cases, this surgery is also an alternative where the patient doesn’t qualify for the open surgery. As compared to open surgery, the endovascular repair stands to be less invasive as it doesn’t include large incision that is normally made in the abdomen or the chest. This process requires very small incisions, which helps in speedy recovery in comparison to other surgical processes.

Open repair of abdominal aortic aneurysms: This surgery type is done for repairing an abdominal aortic aneurysm. It is known by the name, open surgery as in this process the abdomen is opened that helps the surgeon in viewing the aorta in a better way. It is the conventional repair method used by the surgeons. For repairing the aneurysm, your doctor will use a man-made tube known as the graft for replacing the worn out and bulging section of your aorta in the belly. During the process, you will be given general anesthesia. During the surgery, the doctor will make a large incision in your belly or on the side of your abdomen.

The doctor will then put the clamp on the aorta above and below the aneurysm. This helps in stopping the blood flow via the area which was operated. The doctor will then remove the aneurysm and attach the graft to the aorta. In some case of aneurysms, the doctor will leave the aneurysm wall untouched, and the graft will then be placed within the aneurysm. Once the aorta is fixed, the doctor will then remove the clamps which will allow the blood to flow through the aorta once again. Once it is done, the doctor will use stitches or staples for closing the incision in the belly.

Balloon angioplasty and stenting in all vascular areas: Angioplasty make use of imaging guidance technique for inserting a balloon-tipped catheter in the narrow or blocked blood vessel wherein the balloon is inflated for opening the vessel and improving blood flow. The process can even be done with vascular stenting – wherein the placing of a small wire net tube in the blood vessel that helps in keeping it open. The stenting process is quite lesser invasive as compared to other surgical procedures and it normally does not need general anesthesia.

Read More: Coronary Angioplasty: A Life Saving Procedure

Your doctor will guide you in preparing for the process. You will even be advised about any changes that you will have to make to your medication schedule. If there will be a need of admitting you in the hospital overnight, then your doctor will advise you accordingly. You will even be asked to avoid eating or drinking anything few hours prior to the surgical process. You should even make it a point to update your doctor if there's a chance of pregnancy or any other medical condition like allergy or medicines that you are taking. Being clear about the process will help you in preparing perfectly so that surgery goes smoothly.

Carotid endarterectomy and carotid artery stenting: It is a surgical procedure which is recommended for opening or cleaning the carotid artery with the objective of preventing stroke. Carotid endarterectomy happens to be a durable process but it is not a cure as rare blockages have a possibility of accumulating again. Your vascular surgeon will suggest you to undergo carotid endarterectomy if you happen to have a moderate (50-79%) blockage of the carotid artery and the symptoms include stroke, mini-stroke or TIA (transient ischemic attack). It can even be performed if there is a severe blockage, even if there are no symptoms at all.

Hemodialysis access: Hemodialysis access, also known as vascular access, is a way of reaching the blood for hemodialysis. This access helps the blood in traveling via soft tubes to the dialysis machine, wherein it gets cleaned while passing through a special filter, known as the dialyzer. The access is often placed by conducting a minor surgery. If you happen to be a hemodialysis patient, your access will include one among the following:

  • A fistula, it’s an access which is made by joining the artery and vein in the arm
  • A graft, made by a piece of soft tube for joining an artery and vein in the arm
  • A catheter, which is a soft tube placed in a large vein, often in the neck

If the access as made happens to be a fistula or graft, the nurse will place two needles in the access before beginning the treatment. These needles as placed are connected to the soft tubes which go to the dialysis machine. The blood will go to the machine via one of these tubes, and then it will get cleaned in the dialyzer, and then will return to you via the other tube. If your access happens to be a catheter, it will be connected to the dialysis tubes directly and in such cases, the needles will not be needed.

A fistula will be considered as primary choice of access as it normally lasts longer and causes fewer problems like infections and clotting. Fistula is not recommended in patients whose blood vessels aren’t strong enough. A graft is mostly considered as the secondary choice for an access. And catheters on the other hand are normally used as a temporary access, but in some cases they can even be permanent. In some scenarios, you can even be able to switch to a fistula from any other access type. If you were given any other type other than fistula, but can ask your dialysis team for a switch, if there exists a possibility.

Treatment of thoracic outlet syndrome: Thoracic outlet syndrome happens to be a group of disorders which occur when your blood vessels or nerves located in the space between the collarbone and the first rib (thoracic outlet) get compressed. This can result in pain in the shoulders and neck, including numbness in the fingers. Among the commonly known causes of thoracic outlet syndrome, is physical trauma due to car accident, repetitious injuries occurring due to job or activities related to sports, some anatomical defects like having an extra rib and pregnancy. In some cases, the cause of thoracic outlet syndrome is not determined. The treatment process for thoracic outlet syndrome normally calls for physical therapy and pain relief measures. In most people, thoracic outlet syndrome gets to improve their symptoms with these approaches. In certain cases, the doctor can even recommend surgery.

Vascular Bypass Surgery Process

A vascular bypass surgery or vascular graft is a procedure that is carried out for redirecting the blood flow, which was blocked due to the blockage in the artery, from the concerned area to another with the help of reconnecting blood vessels. In most cases, this surgery is done so as to bypass near a damaged artery, from the area of usual blood flow to other area which also has a relatively normal blood flow.

The surgery is commonly done because of the deficient blood flow known as ischemia, which is often caused by atherosclerosis. It can even occur due to organ transplantation, or in the case of vascular access in hemodialysis. During the surgical process, the surgeon will take your own vein, known as autograft, as the graft material (or conduit). However, in some cases, other graft types can also be used such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or for that matter the vein of another person, which is known as allograft. Arteries can even act as the vascular grafts. Your surgeon will sew the graft to the concerned area and the target vessels with the help of hand using surgical suture, thus creating a surgical anastomosis.

Some of the common bypass sites happen to be the heart, coronary artery bypass surgery for treating coronary artery disease, and for legs it is peripheral vascular disease.

Aftercare Process

Following a vascular bypass surgery, you will be kept in the intensive care unit, however; the time you will be kept there would vary depending on the surgery type. It will even have an impact on the recovery time.

The surgery for Abdominal Aortic Aneurysm (AAA) is characterized by the enlargement or “bulge” which usually develops r AAA is quite serious, you can expect to be kept in the intensive care for around 24 hours, and the hospital stay would likely be around 5 to 10 days. This will help you in a healthy and smooth operative as well as postoperative course. In case, you face any complications post surgery, your hospital stay may increase. The complete recovery from an AAA surgery can take around 6 months.

All vascular surgery types carry some extent of risk. A surgery that involves incision carries the risk of infection. Surgeries that are related to chest or the ones involving major blood vessels, have higher risk of complications.

If you smoke or have any medical condition like high blood pressure, kidney disease, chronic lung disease, or any other illness, you will be at a higher risk of complications both during and post surgery.

Some other risks associated with vascular surgery include:

  • Bleeding
  • Heart attack or stroke
  • Failed or blocked grafts
  • Leg swelling, in case a leg vein is used
  • Brain impairment in people above 65 years of age
  • Susceptibility of mental decline, post vascular surgery
  • Impotence

As the surgeries come with various risks, you should make it a point to consult your surgeon and understand the possible risks and ways to minimize them.

Conclusion

Vascular diseases can impact the quality of your life and subject you to various problems. While there are ways to treat the vascular problems, it is always better to follow the preventive care.

It is advised that you maintain a heart-healthy lifestyle. This includes avoid smoking, eating nutritious food that’s low in fat, exercising regularly, maintaining a healthy body weight and controlling various risk factors like high cholesterol, diabetes, high blood pressure and hypertension.

At Shalby Hospitals, Ahmedabad, we bring to you highly effective medical and surgical care for vascular bypass surgery. Our team of expert doctors and surgeons assist in designing the ideal treatment plan for you that offers satisfactory results and speedy recovery. They are well-trained and experienced in performing complex surgeries with high success rate. Right from the diagnosis to treatment process and aftercare, our team assists you at every point to make sure that your quality of life is not compromised.

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