Vascular Bypass Revolution
A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. The other end is attached to an artery in your lower leg. The blood now flows through the graft, instead of through the section of the artery that was narrow or blocked. Improving the blood flow to your foot can relieve pain and help to heal any open areas (ulcers) on your foot. This surgery usually takes 3 to 4 hours.
The vascular bypass allows a blocked artery to be bypassed by implanting a vessel removed from the patient, and this is done in order to create a deviation in circulation. However, in 50% of cases, excessive vascular cell proliferation, called hyperplasia, occurs around the suturing site of the transplanted vessel. Hyperplasia then leads to a decrease in blood flow within five years following the operation, requiring a new surgery.
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Peripheral vascular bypass is named for the artery that will be bypassed and the arteries that will receive the rerouted blood. The three common vascular bypass surgeries are: aortobifemoral (reroutes blood from the abdominal aorta to the two femoral arteries in the groin), femoropopliteal (reroutes blood from the femoral to the popliteal arteries above or below the knee), and femorotibial (which reroutes blood between the femoral artery and the tibial artery).
The life of a surgical bypass depends on the health of your arteries, the type of graft used (natural last longer than synthetic), and other health factors such as whether you smoke, or have diabetes or kidney failure.
The obstructed blood vessel is typically caused by peripheral artery disease (PAD). PAD occurs when plaque builds up on the walls of the arteries (atherosclerosis). This blockage reduces the normal flow of blood that carries oxygen and nutrients to the lower extremities. This causes cells and tissue in the legs and feet to die from lack of oxygen and nutrition. Normal growth and cell repair cannot take place, which can lead to gangrene in the limbs and subsequent amputation in the worst cases.
Dogma in vascular bypass technique says to obtain proximal and distal control. This means that in a vessel with flow through it, a surgeon must be have exposure of the furthest and nearest extents of the blood vessel in which the bypass is being created, so that when the vessel is opened, blood loss is minimized. After the necessary exposure, clamps are usually used on both the proximal and distal end of the segment. Exceptions exist where there is no blood flow through the target vessel at the area of proposed entry, as is the case with an intervening occlusion.