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 and splits into two smaller blood vessels called femoral arteries. These arteries carry blood and oxygen to your pelvis 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. 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.

Getting Ready

Before your surgery:

• Ask a family member or friend to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your surgery.
  
  
• You may need to have blood tests before your surgery. A computed tomography scan or duplex ultrasound may be done to look at your pelvis, legs, and blood vessels. An ankle-brachial index test may be needed to check for blood vessel disease. You may also need an angiography to check the blood flow through your blood vessels. If you are having symptoms of heart problems, you may need a stress test, echocardiography, or a cardiac angiography. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Antibiotics: Antibiotics may be given to help prevent an infection caused by germs called bacteria.
  
  
• Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, or 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.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery. Tell your caregiver if you or anyone in your family has had a problem having anesthesia in the past.

Treatment

What will happen:

• You will be taken to the room where your surgery will be done. You will get general anesthesia medicine to keep you asleep. During surgery, incisions 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 aorta and femoral arteries will be clamped above and below your blockage. 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 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• You get sick (cold or flu) or have a fever.
  
  
• You see new color changes in your feet or toes.
  
  
• Your leg pain is becoming worse.
  
  
• You have new ulcers on your legs or feet.

Seek Care Immediately if

• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have sudden, painful color changes in your toes to blue or black.
  
  
• You have new or worsening leg pain when you are resting.