Consent:Peripheral Bypass

Nature

Operation to bypass a blocked artery so that blood flow to the distal parts is improved. To do the bypass the surgeon needs;

• Proximally, a good artery with adequate blood flow to supply the bypass with blood

• A suitable conduit to form the bypass, that carries the blood to the distal recipient artery eg. vein or plastic tubing (choice depends on availability of vein and nature of bypass). Before the operation the surgeon may request imaging of the veins in the lower limb with marking of a vein that appears suitable

• Distally, an open artery with the ability to accept the blood flow from the bypass

The success of the operation depends on these three factors, as well as technical aspects of the operation. Longer term success depends on risk factor reduction by the patient, medications and exercise;

Risk factor reduction

• cessation of smoking
• control of hypertension
• control of diabetes
• control of hypercholesterolemia

Drugs

• Aspirin or other antiplatlet drugs. Sometimes the surgeon recommends Warfarin in-combination with or as an alternative to aspirin.
• Statin like drugs

Exercise

This is the main factor that improves walking distance and is felt to encourage the development of collateral circulation around the blocked arteries

Alternatives

• Do nothing
• Risk factor reduction, Drugs and exercise as outlined above
• Drugs have little role
• Sympathectomy - may relieve some pain and heal superficial skin ulcers
• Primary amputation - is the main option in patients with no possibility of reconstruction. Or may be the best choice for a patient who would require a very risky bypass who would not be fit for several operations.

Benefits

• Improvement in walking distance,
• Less pain
• Healing of ulcers and wounds
• Avoidance of amputation

Risks

• Risks of the anaesthetic
• Bleeding, infection and ugly scar from any incision
• Collection of blood in wound which may require a further operation
• Failure of the bypass to function, this may result in further surgery, and loss of the limb. Risk of this depends on the severity of the underlying arterial disease, in particular the ability of the recipient artery to take enough blood to maintain blood flow in the bypass graft.
• Infection of the bypass, especially if plastic is used, this may result in further surgery, loss of the limb and rarely death
• In the longer term, the bypass may become blocked, this may result in the return of symptoms.
• Risk of Deep Venous Thrombosis and its sequelae