Artery Bypass

About the Procedure

Arterial Bypass Surgery is a general term for creating an alternate passageway for blood flow which has been blocked by atherosclerosis (hardening of the arteries). In addition to coronary artery bypass, femoral artery (lower extremity) bypass and cerebral artery bypass are the most frequently performed. Patients with atherosclerosis in one area of the body have a higher incidence of the disease in other areas. The flow of blood is impinged by the build up of plaque along the sides of the artery, depriving the area of necessary oxygen and nutrients. The donor vessel, or graft, is usually a healthy vein or artery from the patient's leg, arm, or chest.

An arterial bypass procedure is performed by a vascular or cardiac surgeon in a hospital with general, epidural, or spinal anesthesia. The surgeon first selects and removes the vessel which will serve as the bypass graft. An incision is made in the skin above the blocked artery and the doctor evaluates the severity of the blockage to assure the appropriate procedure is used. At a position prior to the blockage, the graft is permanently stitched to the artery. It is then routed through nearby muscles and other soft tissue to a location beyond the blockage where it is stitched. The surgeon may order an arteriogram or ultrasound to confirm the success of the procedure and to check for leakages. All incisions are then closed. Techniques used in each type of bypass may vary particularly with new technological advances intended to provide minimal invasion and better outcomes with fewer complications and risks. In a new, laser-assisted technique, the bypass is performed without interrupting the blood flow in the diseased artery. By threading a laser through the donor graft until it reaches the intended artery, radiation is used to attach the graft to both sides of the blockage while blood continues to flow, an important development in cerebral artery bypass.

What to Know Before the Procedure

Complications during bypass surgery are not frequent but the risk of bleeding, infection, embolism, stroke, and/or heart attack can be serious. Newer techniques, while promising, may not have been in practice long enough for sufficient studies to support them. Selecting a surgeon with expertise and considerable experience in performing the particular surgery required is linked with fewer complications and better outcomes.

Preparation for arterial bypass surgery may include tests which will assist the surgeon in locating the blockage and deciding where to attach the graft. Routine pre-admission tests will be scheduled prior to the procedure and the doctor will provide pre-surgery instruction. The surgeon will advise the patient regarding all medications, prescribed and over-the-counter to avoid conflicts with surgery and blood-clotting issues.

What to Know After the Procedure

Patients spend a day or two in the recovery area and, depending on the type of bypass, the hospital stay can be from three to ten days. After leaving the hospital the recovery time can vary greatly. Daily activities should be taken on slowly and with caution, and lifting or pushing heavy items is discouraged for weeks. Advanced planning should be made for a driver at discharge and assistance from family or a home care agency during the first few days after leaving the hospital.

If you Need to Travel Outside of your Local Hospital

While complications for arterial bypass procedures are stated to be few, areas such as the heart, brain, and a major limb are so vital to life, that all aspects of selecting the surgeon and facility for the operation must be given the utmost consideration. The age of the patient, the specific level of disease, other health concerns, and likelihood of complications must be discussed with the doctor prior to making a decision on where to have this procedure done. There may be a large cost-savings with having this procedure performed abroad. In cases where the decision is made to have this procedure done internationally, the patient must be aware of typical recovery times and travel restrictions in order to prevent serious post-operative complications.