Our Summary

This study looked at the results of different types of surgery used to treat atherosclerotic occlusive disease in the femoral arteries (the main arteries of the thighs). Traditionally, this has been treated with open surgery, but more recently, a combination of open and endovascular surgery (surgery performed inside the blood vessels) has been used.

The researchers used data from 4,478 patients who had undergone one of these types of surgery between 2012 and 2017. They looked at complications related to the heart, lungs, and kidneys, as well as death. They then compared these outcomes for the different types of surgery.

They found that the risk of these complications or death was not significantly different between the combination surgery and either type of open surgery. However, open surgery was associated with a higher risk of deep surgical-site infections, sepsis after surgery, unexpected readmissions within 30 days, and general complications.

Patients who had leg pain while walking (claudication) and underwent the combination surgery had fewer complications compared to those who underwent open surgery.

In conclusion, patients with claudication who underwent the combination surgery experienced fewer systemic complications than those who underwent open surgery. However, there seems to be no increased risk of systemic complications or death with open surgery when compared to combination surgery for other reasons. Other complications, such as infection, the need for a blood transfusion after surgery, and readmission, were more common in the open surgery groups.

FAQs

  1. What types of surgery were compared in this study for treating atherosclerotic occlusive disease in the femoral arteries?
  2. According to the study, which type of surgery is associated with a higher risk of complications such as deep surgical-site infections, sepsis, and unexpected readmissions within 30 days?
  3. Did the study find any significant difference in the risk of systemic complications or death between open surgery and combination surgery?

Doctor’s Tip

One helpful tip a doctor might give to a patient undergoing femoral-popliteal bypass surgery is to carefully follow post-operative care instructions to reduce the risk of complications. This may include keeping the surgical site clean and dry, taking prescribed medications as directed, attending follow-up appointments, and participating in any recommended physical therapy or rehabilitation programs. It is also important to promptly report any signs of infection, such as increased redness, swelling, or drainage at the surgical site, to your healthcare provider. By following these guidelines, patients can help ensure a successful recovery and minimize the risk of complications.

Suitable For

Therefore, patients who are typically recommended for femoral-popliteal bypass surgery are those with claudication (leg pain while walking) who may benefit from the combination of open and endovascular surgery to reduce systemic complications. Other patients who may benefit from this surgery are those with severe atherosclerotic occlusive disease in the femoral arteries that cannot be effectively treated with other interventions. It is important for patients to discuss their individual situation with their healthcare provider to determine the best treatment option for them.

Timeline

Overall, the timeline for a patient before and after femoral-popliteal bypass surgery would involve the following steps:

Before surgery:

  • Patient experiences symptoms of atherosclerotic occlusive disease in the femoral arteries, such as leg pain while walking.
  • Patient consults with a vascular surgeon to discuss treatment options.
  • Patient undergoes pre-operative testing and evaluation to determine the best course of treatment.
  • Patient is scheduled for femoral-popliteal bypass surgery.

During surgery:

  • Patient undergoes either open surgery or a combination of open and endovascular surgery to bypass the blocked arteries in the thighs.

After surgery:

  • Patient is monitored in the hospital for any immediate complications, such as bleeding or infection.
  • Patient may experience pain and discomfort at the surgical site.
  • Patient begins physical therapy and rehabilitation to regain strength and mobility in the affected leg.
  • Patient is discharged from the hospital and instructed on post-operative care, including medication management and wound care.
  • Patient follows up with the vascular surgeon for regular check-ups and monitoring of the bypass graft.

Overall, the goal of femoral-popliteal bypass surgery is to improve blood flow to the lower extremities and relieve symptoms of atherosclerotic occlusive disease. The timeline for a patient before and after surgery involves a combination of pre-operative preparation, surgical intervention, and post-operative recovery to achieve the best possible outcome.

What to Ask Your Doctor

Some questions a patient should ask their doctor about femoral-popliteal bypass include:

  1. What are the potential risks and complications associated with femoral-popliteal bypass surgery?
  2. How does the combination of open and endovascular surgery compare to traditional open surgery in terms of outcomes and complications?
  3. Will I need a blood transfusion after surgery?
  4. What is the expected recovery time and rehabilitation process following femoral-popliteal bypass surgery?
  5. How likely am I to experience deep surgical-site infections or sepsis after surgery?
  6. What are the chances of needing to be readmitted to the hospital within 30 days of surgery?
  7. How will my leg pain while walking (claudication) be impacted by the surgery?
  8. Are there any alternative treatment options for atherosclerotic occlusive disease in the femoral arteries?
  9. How many of these surgeries have you performed, and what is your success rate?
  10. Are there any specific lifestyle changes or medications I should consider before or after surgery to improve my outcomes?

Reference

Authors: DeCarlo C, Boitano LT, Sumpio B, Latz CA, Feldman Z, Pendleton AA, Chou EL, Stern JR, Dua A. Journal: Ann Vasc Surg. 2021 Apr;72:227-236. doi: 10.1016/j.avsg.2020.08.143. Epub 2020 Sep 11. PMID: 32927041