INTRODUCTIONThis brochure provides a general overview of surgical treatment for arterial disease in the legs. Please be aware that your individual situation may differ from what is described here.ARTERIAL VASCULAR DISEASEAn arterial stenosis only causes symptoms of intermittent claudication (intermittent claudication) if it occupies 50% or more of the blood vessel's diameter. In that case, blood flow behind the stenosis is significantly reduced. Doppler and/or duplex imaging are used to diagnose symptoms and assess their severity. Besides the severity of the stenosis, the length of the stenosed section is also important.
It is common to have several stenoses in succession along a single blood vessel. A common example is the combination of a stenosis in a pelvic artery followed by a stenosis in the femoral artery in the same leg.TREATMENT PLANIf the symptoms of a vasoconstriction or a vasoconstriction and the findings of the vascular examination are such that lifestyle changes are insufficient, the specialist will discuss the options for more drastic treatment with you. In principle, the specialist will determine whether angioplasty (stretching) of a vasoconstriction is possible or whether surgery is the only option. To make this decision, X-rays of the blood vessels are often necessary.
Before treatment, it is crucial that all abnormalities are clearly identified. The highest vasoconstriction should generally be treated first. This will often sufficiently reduce the symptoms, so that surgery or angioplasty of this highest vasoconstriction (in the example mentioned above, the pelvic artery vasoconstriction) is sufficient.SURGICAL TREATMENTYour arterial disease in the legs may require abdominal surgery on the abdominal and/or pelvic arteries. However, this is beyond the scope of this information leaflet.
If the vascular blockage is in the femoral artery, vascular surgery in the thigh will be necessary. This may be the case if the symptoms are so severe that they constitute critical ischemia. This means you experience pain primarily at night or wounds that refuse to heal. For patients with disabling claudication, who do not respond to walking exercises and for whom angioplasty is not possible, bypass surgery can sometimes be beneficial.THE BYPASS OPERATIONDuring bypass surgery, a bypass is created for the blocked or severely narrowed femoral artery. The upper connection of the bypass will be made at the groin level, connected to the femoral artery. For the lower connection, a location is found in the blood vessel below the blockage using a pre-operative duplex scan or angiography. This can be above the knee (supragenual bypass) or below the knee (infragenual bypass).
The surgery can be performed under general anesthesia or regional anesthesia (a spinal anesthetic numbs only the lower part of the body).
The long-term patency of the bypass depends on its length (the shorter the better), diameter, and quality.
There are different types of bypasses:
- a bypass using the patient's own vein, or
- a bypass made of biological material (umbilical vein), or
- synthetic material.
For the above-the-knee bypass, the use of a patient's own vein, biological material, or synthetic material makes little difference to long-term patency. For the infragenual bypass, a native vein is preferred, provided it is of good quality.
The vein used for the bypass is also located in the thigh and returns blood from the leg to the heart. This vein can be omitted, as the main veins, which are by far the most important for returning blood, lie deeper in the leg. This vein is also removed, for example, during surgery for varicose veins. If you have undergone varicose vein surgery in the past, or if this vein is too thin or blocked due to a previous phlebitis, you may no longer have a usable vein for a bypass. This can be a reason to use a synthetic bypass.AFTER THE OPERATIONAfter surgery, several things are frequently monitored, both in the recovery room and on the ward
: the pulsation of the arteries in your foot,
wound leakage,
leg and arm temperature, and
blood pressure.
You should resume walking as soon as possible after surgery.
Early detection of new blockages can prevent bypass blockages through prompt intervention. Monitoring by the vascular laboratory plays a role in this.COMPLICATIONSDue to the risk of complications, surgical treatment is usually only considered if the symptoms are severe enough to warrant surgery.
No procedure is without the risk of complications. These surgeries also carry the normal risks of complications, such as wound infection, bleeding, thrombosis and pulmonary embolism, pneumonia, bladder infection, or heart attack. Furthermore, you can expect that normal sensation in the area of the surgical scar will have disappeared after healing.
Arterial surgery also has specific complications:
- secondary bleeding or
- occlusion of the vascular prosthesis or the used vein (thrombosis).
If such a complication occurs, further surgery is often necessary. Naturally, every effort is made to minimize the risks. Therefore, you will often be thoroughly examined by an internist, cardiologist, or pulmonologist before surgery, and numerous precautions will be taken.HOME AGAINAfter surgery, you will need to continue taking medication to thin your blood. Recovery may take longer than you expect. Diabetes, high blood pressure, or high cholesterol, if present, must be well controlled.
A healthy lifestyle is very important, so: absolutely no smoking, plenty of exercise, not being overweight, and well-regulated blood pressure, blood sugar, and cholesterol levels. |
