Lower limb bypass surgery

Bypass operations are performed to improve the circulation to the leg. This may be for limiting symptoms of claudication or to try and save the leg from amputation.

The operation is designed to carry blood from a working artery above the blockage to a working artery below the blockage using either a vein or a plastic graft. Before surgery, the blood flow will have been assessed with Duplex scans and/or a dye test to show the best place for the graft to begin and end. genrally the graf twill be from the groin to around the knee, but occasionally it may run from the shoulder of just above the groin, or go down to the calf or foot. Your surgeon should discuss the details of your operation in detail with you.

You may also have a scan to assess the vein in the leg for suitability as a graft, but if it has previously been removed, or is too small or too varicose then a plastic graft may be required.

Cuts will be made in the leg over the pulse in the groin and around the inside of the knee, if the vein is being used then a longer incision is needed to achieve this. The incisions will be closed with stitches or clips at the end of the operation.

You will be admitted the day before or on the day of surgery. You should not eat or drink from midnight on the day of the operation. You will be seen by the surgical team and sign the consent if not already done, and the anaesthetist will see you to explain about going off to sleep. The ward staff will help you change into a theatre gown, and you will be taken to the anaesthetic room in the theatre department. You will be seen by the anaesthetic team and either have a needle in the back of your hand which will be used to put you gently to sleep, or an epidurla inserted for the operation. Once you are asleep a urinary catheter will be placed, since you will struggle to get to the bathroom at your usual pace for the first couple of days after surgery.

After the operation you will wake up in the recovery suite, and remain there for a couple of hours until the team are happy to move you back to the ward.

The drips and catheter will be removed as you begin to emobilise. You should be sitting out of bed on day 2 and walking to the bathroom at about 4 days. Most people are looking to go home at about 7 days.

You will feel some discomfort in the leg as the incisions heal, and it may be several weeks before you can walk freely. However, the symptoms you had preoperatively should be improved immediately. Take it steadily and don’t overdo it.

We will see you in the clinic at 6 weeks to check that you are pretty much back to normal, and the wound is healed well. About a quarter of patients are still on the mend at this stage, particularly patients over 75.

You will not need further clinic appointments but will get regular 6 month checkups in the vascular laboratory for about 18 months. A small number of patients get excessive scarring at the graft, which can produce significant narrowing again. We can usually avoid the graft failing by picking this up on the scans.

You will need to be on aspirin or something similar for ever, and should never smoke again. Both of these measures are important to prevent the graft blocking off, in which case your leg may be more severely affected and we can’t always save it.

Bleeding, Graft failure, Reperfusion, Infection & Numbness