Why is Aortoiliac and aortofemoral bypass graft surgery needed?

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Aortoiliac occlusive disease

Aortoiliac occlusive disease is also known as Leriche syndrome. It is a disease of the central artery in which abdominal aorta gets blocked during evolution into the iliac arteries. 

Signs and symptoms of aortoiliac occlusive disease are reduced femoral pulses, claudication of the thighs and buttocks, shortness of breath, dizziness, nausea, sweating and erectile dysfunction. Primary physical tests are done to check weak femoral pulses. Digital subtraction angiography is often used to verify the endovascular treatment and diagnosis in the same trial. Colour duplex scanning is employed to verify the diagnosis. Nature of obstacles is determined using MRA and multi-detector CTA. 

Aortoiliac femoral angiogram 

The angiographic image of aortoiliac involves external iliac artery, common iliac artery, internal iliac artery, deep circumflex artery, common femoral artery, lumber branch, abdominal aorta, inferior & superior gluteal arteries, median sacral artery and inferior mesenteric artery. 

What is Aortoiliac and aortofemoral bypass graft? 

In this surgery, synthetic grafts are positioned near a point where the blood vessels are obstructed. These grafts or tubes are positioned on the femoral arteries and aorta to enable the flow of blood around the obstruction. The aorta is responsible for circulating blood to the organs of the body. This artery gets bifurcated into two iliac arteries and then near the groin the iliac arteries transform into femoral arteries. 

Why is Aortoiliac and aortofemoral bypass graft surgery needed?

It is needed to complement the flow of blood from lower to the upper part of the body through femoral arteries, iliac arteries and aorta. Aortofemoral bypass graft is used to treat atherosclerosis which causes plaques along the lining of the blood vessels. As a result of this obstruction, tissues are unable to receive sufficient oxygen which gradually results in nerve damage, cold legs or feet, pain in the legs, retarded healing, redness in the area, itchiness and ulcers. Aortoiliac and aortofemoral bypass graft help in removal of these blockages. 

Preparation for graft surgery

Before surgery few physical tests are performed like a blood test, ultrasound, angiography and ankle-brachial index. 

Ultrasound is done to detect blocked blood vessels. It is performed using sound waves which check the flow of blood in the vessels. The ankle-brachial test is conducted to check blood pressure in the legs and arms. If the pressure in the legs is considerably lower than arms then it signifies a blockage in the leg arteries. Along with regular angiography, MR and CT angiography are commonly performed to inspect the exact area of obstruction. In angiography, the dye is injected in the body to see the point of a hindrance.

Treatment procedure

First, anesthesia or local anesthesia is given to numb the body or to force the patient into sleep so that he will not experience any pain. A small or large cut, depending on the condition, is made to reach the blocked blood vessel. Often organs are carefully handled which comes in the path. The blood is inhibited from each side of the blocked blood vessel using clasps where the graft is then positioned. One side is attached to the aorta above the stoppage while the other side is attached with the aortoiliac arteries below the stoppage. After this, clasps are withdrawn and the muscles are fastened together when unhindered blood flow is observed. The abdominal incision is also stitched at last. 

Recovery from Aortoiliac and Aortofemoral bypass graft surgery

The patient is kept for at least 2 days and up to 7 days in the hospital after surgery where his health is monitored in the intensive care unit. A tube is often placed in the body through the nostrils to help in the intake of liquids. The functioning is usually disturbed after surgery and solid food is not suitable in this case as the stomach is unable to digest food for some time. This tube supplies the diet to the stomach to regulate its functioning. Gradually, the patient can shift to their normal diet. A spirometer is placed for the lungs to help prevent pneumonia. Regular medications are used as supplements for complete and early recovery. To prevent complications or infections one should not touch the incision while keeping it covered, should wash hands, and instruct visitors for the same – masks and gloves should be used to avoid infections. 

The patient is expected to maintain hygiene to reduce the risks of infection. Generally, 5-6 weeks rest is compulsory for proper and faster recovery. To regain strength and normal functioning one can visit a therapist. Mild pain and swelling are expected after surgery – but in case of increasing pain, extreme swelling, fluid leakage from the cut, nausea, frequent urination, blood in urination, redness around the operated area, shortness of breath, severe cough and chest pain consult your doctor immediately. Food with high cholesterol and fat such as cream, butter, cheese, ice cream, whole milk, meat, eggs yolks, cakes and baked desserts should be avoided for faster recovery.

Aortofemoral bypass complications

Though complications are rare in this surgery – Some potential complications are bleeding, nerve damage, scarring, infections, complications due to anaesthesia and acute blood clots. Abstain from drinking and smoking – health problems like diabetes, obesity and other heart diseases must be informed to your physician beforehand. 

Benefits of aortoiliac and aortofemoral bypass graft surgery 

Among many benefits, the most important is that it is successful almost 80% of times. Complications are rare, negligible pain, short stay in the hospital after surgery and easily available in the hospitals. 

Axillofemoral bypass

Sometimes instead of aortofemoral bypass graft surgery, axillofemoral bypass surgery is performed. This surgery is used to treat aortoiliac occlusive disease in patients who are unable to be cured by aortofemoral bypass surgery.  In this surgery, dissection of the femoral artery is done to check the occlusive disease. Initially, three incisions are made to tunnel the tube in them. When circulation starts in the tube it makes a J shape along the artery. This procedure has its advantages, like from anastomosis to the femoral artery, it provides a high rate of blood flow, this procedure increases forward angle of outflow through the anastomoses, the fourth anastomosis is prevented with the help of this surgery and quantity of prosthetic material is lessened. 

FAQs

What is the cost of the aortoiliac and aortofemoral graft surgery?

The cost of bypass surgery ranges between $5000 and $8000. But other required tests can add up to $10,000 which makes it an expensive treatment. 

What are the side effects of this surgery?

The side effects include infection in the graft or wound, bleeding, risk of stroke, sexual dysfunction, pain and swelling in the legs, feet or calves. They are not common though.

How long does this surgery take to be completed?

The surgery procedure usually takes 3-5 hours but the recovery itself takes 3-4 hours. You can be kept overnight before the surgery. All this combined with preparation can take several hours. 

How to prepare for aortoiliac and aortofemoral graft surgery?

The patient should be accompanied by someone, all medications must be stopped at least one week before surgery, do not eat or drink anything for 10 hours before surgery and must bring necessities as the patient may need to stay for some time in the hospital.

Is this surgery painful?

The surgery is not painful as anaesthesia is administered beforehand so that there will be no occurrence of pain and discomfort. After surgery, there can be slight pain in the operated area for some time