What is it?
The main artery that carries blood from your heart down to your legs is blocked near your tummy button. The legs are starved of blood. This causes pain in the legs, the risk of serious infection and even loss of the limbs. The arteries below the blockage are in much better shape. They could take more blood flow. You would then get rid of the pain in your legs, and infection would heal up. In your case a supply of blood can be channelled from an artery just below your collar-bone to your leg arteries in the groins. This is done by threading a new artificial plastic artery under the skin from the collar-bone artery to the groin arteries. Sometimes a new artery is put down each side. Sometimes a Y-shaped artery is used to take blood from one collar-bone artery to both groin arteries. The exact plan for you will be explained. If all goes well, the arm and head should not be starved of blood by these operations. You can feel the new artery beating but this is not troublesome.
The operation
You will have a general anaesthetic, and will be asleep for the whole operation. One cut is made into the skin below the collar-bone and a cut is made in each groin to find the arteries. Tunnels are made under the skin to make a path for the new artificial artery. Sometimes an extra skin cut is needed over the bottom of your ribs where the new artery runs. The arteries are joined up and the cuts are stitched up. You should notice warm feet and loss of pain within 24 hours. If all goes well, you should plan to leave the hospital seven days after the operation.
Any alternatives
You will have a general anaesthetic, and will be asleep for the whole operation. One cut is made into the skin below the collar-bone and a cut is made in each groin to find the arteries. Tunnels are made under the skin to make a path for the new artificial artery. Sometimes an extra skin cut is needed over the bottom of your ribs where the new artery runs. The arteries are joined up and the cuts are stitched up. You should notice warm feet and loss of pain within 24 hours. If all goes well, you should plan to leave the hospital seven days after the operation.
Before the operation
Stop smoking and try to get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation in the safest possible way. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - in hospital
You will have a fine, thin plastic drip tube in an arm vein connected to a plastic bag on a stand containing a salt solution or blood. You will have dressings on your wounds and possibly fine, plastic drainage tubes in the nearby skin connected to plastic containers. These are in order to drain any residual blood or other fluid from the area of the operation. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. The wounds may be painful and you will be given injections and later tablets to control this. Ask for more if the pain is not well controlled or if it gets worse.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during this time. The nurses will help you with everything you need until you are able to do things for yourself. You will most likely be able to get out of bed with the help of the nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after the operation you should be able to spend an hour or two out of bed. By the end of four days you should have little pain.
It is important that you pass urine and empty your bladder within 6 to 12 hours of the operation. If you cannot pass urine, let the doctors and nurses know. They will take steps to correct the problem. Each wound has a dressing which may show some staining with old blood in the first 24 hours. You can take the dressings off after 48 hours. There is no need for dressings after this unless the wounds are painful when rubbed by clothing. There may be stitches or clips in the skin. The wounds may be held together underneath the skin with stitches that are dissolvable and don’t need to be removed. Any plastic drainage tube is taken out after two days or so.
There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after two to three days. This is expected and you should not worry about it. There may be some swelling of the surrounding skin which also improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been removed. Try to keep the wounds dry until the stitches/clips come out which happens about 10 to 14 days after the operation. If there are only stitches under the skin, try to keep the wounds dry for a week. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave hospital. The nurses will advise about sick notes, certificates etc.
After - at home
You will have a fine, thin plastic drip tube in an arm vein connected to a plastic bag on a stand containing a salt solution or blood. You will have dressings on your wounds and possibly fine, plastic drainage tubes in the nearby skin connected to plastic containers. These are in order to drain any residual blood or other fluid from the area of the operation. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. The wounds may be painful and you will be given injections and later tablets to control this. Ask for more if the pain is not well controlled or if it gets worse.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during this time. The nurses will help you with everything you need until you are able to do things for yourself. You will most likely be able to get out of bed with the help of the nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after the operation you should be able to spend an hour or two out of bed. By the end of four days you should have little pain.
It is important that you pass urine and empty your bladder within 6 to 12 hours of the operation. If you cannot pass urine, let the doctors and nurses know. They will take steps to correct the problem. Each wound has a dressing which may show some staining with old blood in the first 24 hours. You can take the dressings off after 48 hours. There is no need for dressings after this unless the wounds are painful when rubbed by clothing. There may be stitches or clips in the skin. The wounds may be held together underneath the skin with stitches that are dissolvable and don’t need to be removed. Any plastic drainage tube is taken out after two days or so.
There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after two to three days. This is expected and you should not worry about it. There may be some swelling of the surrounding skin which also improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been removed. Try to keep the wounds dry until the stitches/clips come out which happens about 10 to 14 days after the operation. If there are only stitches under the skin, try to keep the wounds dry for a week. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave hospital. The nurses will advise about sick notes, certificates etc.
Possible complications
As with any operation that is done under general anaesthetic, there is a risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will reduce the chances for such complications.
Complications are rapidly recognised and dealt with by the surgical staff. If you think that all is not well, please let the doctors and the nurses know. Sometimes there is some bleeding under the wounds which causes more severe bruising. This settles down. However, there is a small chance of severe bleeding in the area of the operation that might require another operation to stop it.
Sometimes the blood in the new artificial artery clots. This usually needs a second operation to clear the blockage. Sometimes the arteries further down on one or both legs cannot take the extra flow of blood. The next steps to deal with this will be discussed with you. The worst case scenario is that the a satisfactory blood supply to the leg cannot be restored in which case you may need an amputation (removal of the diseased part of the leg).
Wound infection is sometimes seen. This settles down with antibiotics in a week or two. It is much more serious if the infection spreads in your bloodstream or if the new artificial artery gets infected. If this is the case you will need antibiotics for much longer and it may be that the new artificial artery has to be removed to allow the infection to clear. Sometimes fluid builds up under the wounds. This settles down with time.
There is a very small chance that you will experience in your arm, forearm or hand on the side of the collar bone where the new artificial artery is stitched what is called steal syndrome. This is a feeling of pins and needles, numbness, coldness or even pain. This happens because the new artificial artery “steals” or diverts more blood than your upper healthy limb can afford to give to the diseased leg(s). The upper limb needs this blood to maintain its circulation and function. The problems that you experience in your upper limb usually get better but there is a chance that the artificial artery has to be removed to save your upper limb and prevent further problems.
Extremely rarely, when the new artificial artery is much shorter than it should be, it can be ripped off the artery under the collar bone when you stretch (abduct) your. This is very serious and life-threatening complication and requires an emergency operation to fix the problem.
Aches and twinges may be felt in the wound for up to six months. Occasionally there are numb patches in the skin around the wound which get better after two to three months.
You should avoid tight clothing or corsets and avoid sleeping on the side of the new artery especially if you are overweight because this can collapse and clot the artery.
The overall results of this operation are relatively good. About 50% of artificial arteries in axillo-femoral bypasses remain open five years after the operation and patients enjoy a good quality of life.
General advice
The operation may sound unusual, but is routine in many hospitals. However, as with all operations in blood vessels it should not be underestimated. You should never smoke after the operation. These notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
