Aortofemoral Bypass

WHAT YOU SHOULD KNOW:

• Aortofemoral bypass is surgery to repair your blocked or damaged aorta. The aorta is a large blood vessel that leaves your heart and carries blood and oxygen to your body. Your aorta travels down your abdomen (stomach) and splits into two smaller blood vessels called femoral arteries. These arteries carry blood and oxygen to your pelvis (hips) and into your legs. You may need this surgery if you have blood vessel disease or an aortic aneurysm (a bulging, weakened area of the vessel wall). You may also need aortofemoral bypass surgery if you have claudication or lower leg ulcers (wounds). Claudication occurs when you have pain and tiredness in certain leg muscles when you are active. Aortofemoral bypass surgery may also be needed after a kidney transplant to improve the blood flow to the new kidney.
  
  
• During surgery, a graft is attached to your aorta to go around the blocked area of the vessel. The graft connects your aorta to one or both of your femoral arteries. A graft is a tube used to replace your blood vessel. Your graft may be man-made or a healthy blood vessel from your leg may also be used. Aortofemoral bypass may improve the blood flow to your legs and feet, and decrease your risk for ulcers. Aortofemoral bypass may also decrease your symptoms such as leg pain making it easier to do your daily activities.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the medicines used during, and after your surgery. During surgery, you may bleed more than expected, have heart problems, and you may die. After surgery you may get a lung infection and have trouble breathing. You may have abdominal pain, and your kidneys may not work properly. Your new graft may narrow, become blocked, and get infected. The blood flow to your legs and feet may become blocked again, and you may need another surgery. A graft infection may increase your risk of needing your leg or foot amputated (cut off).
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening. After surgery, you may also have a heart attack, and you may die.
  
  
• If you do not have surgery, the blood flow to your legs and feet will not get better. You may have worsening leg pain making it hard for you to walk. The ulcers on your legs and feet may worsen and become infected. A severe infection may cause sepsis (blood infection). You will have a greater risk of needing a leg or foot amputation. Without surgery, your risk is also greater for having a stroke or heart attack, and you may die. Talk to your caregiver about any questions or concerns you have about your surgery or treatment.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. You will have a heart monitor on during and after your surgery.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria. You may be given antibiotics before, during, and after your surgery.
    
    
  • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after your surgery. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
  
  
• Pre-op care: You may be given medicine right before your surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your surgery will be done, and then you are moved to an operating table.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

During your surgery:

• During your surgery, incisions (cuts) will be made in the area of your hips to reach your femoral arteries. Another cut will be made in your abdomen to reach your aorta. Your caregiver will carefully move other blood vessels and organs out of the way. Your aorta will be clamped just above the area of your blockage or narrowing. Clamps are also placed on your femoral arteries below the areas to be worked on. The clamps are used to stop the blood flow through the blood vessels during surgery.
  
  
• One end of a graft is then sewn to your aorta just above the blockage. The other end of the graft will go around the blocked area and be sewn to your femoral arteries. Once the graft is secured in place, the clamps will be removed. Your blood flow to your legs and feet will now travel through the graft, around your blocked blood vessel. Your caregiver will check for any bleeding. Your other blood vessels and organs will be moved back into place. Your cuts will then be closed with stitches or staples.

After your surgery:

A bandage will be placed over your wounds (surgery sites) to prevent bleeding. The bandage will also help keep the areas clean and dry to prevent infection. You may be taken to a room where you can rest until you are fully awake. Caregivers will watch you closely for any problems. A caregiver may remove your bandage shortly after surgery to check your wound. Do not get out of bed until your caregiver says it is OK.

• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths).
  
  
• Blood sugar tests: Caregivers may monitor your blood sugar closely after surgery. This may help decrease your chance of getting an infection.

Medicines:

You may be given the following medicines:

• Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
  
  
• Heart medicines: You may need different medicines to control your heartbeat and blood pressure.
  
  
• Pain medicines: Your caregiver may give you medicine to decrease your pain. Tell your caregiver if your pain does not get better after taking your medicine. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Your caregiver may also give you the following:
  
  
  • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.
    
    

Activity:

Your caregiver may have you get out of bed to walk shortly after your surgery. Walking may help decrease your risk for blood clots and lung infections.

Deep breathing and coughing:

Deep breathing and coughing helps keep you from getting a lung infection after surgery. Deep breathing opens the airways going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should breathe deeply and cough every hour while you are awake.

• Hold a pillow tightly against your wound when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while you are awake. Remember to follow each deep breath with a cough.
  
  
• You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your spirometer every hour while you are awake. When you are asleep, caregivers may need to wake you up every 2 to 4 hours to use your spirometer.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.