Our Summary

Peripheral artery disease refers to a condition where the arteries, primarily those supplying blood to the legs, are blocked. This disease affects over 200 million people globally and can cause severe pain, especially when walking, or even lead to critical limb ischemia, a condition that could necessitate amputation.

To treat this, lifestyle adjustments, medication, and supervised exercise are usually recommended, but in some cases, it may be necessary to perform a procedure to restore blood flow in the limb. One method involves a surgical bypass, particularly for longer and more complex blockages. However, this surgery carries significant risks, including potential death.

Advancements in less invasive procedures, such as balloon angioplasty and the use of drug-eluting stents, drug-coated balloons, and particular types of covered stents are quickly evolving. These advancements might soon challenge the traditional surgical bypass as the preferred method of treatment.

This paper looks at which technique is best suited for different types of blockages, particularly more complex ones, and it provides a summary of the latest and most relevant research on this subject.

FAQs

  1. What is peripheral artery disease and how many people does it affect worldwide?
  2. What are the different treatment options for femoropopliteal lesions in peripheral artery disease?
  3. What are some of the potential risks or complications associated with bypass surgery for peripheral artery disease?

Doctor’s Tip

A doctor may advise a patient undergoing peripheral artery bypass surgery to closely follow post-operative care instructions, including keeping the surgical site clean and dry, taking prescribed medications as directed, and attending follow-up appointments with their healthcare provider. They may also recommend lifestyle changes such as quitting smoking, eating a healthy diet, and engaging in regular physical activity to improve long-term outcomes.

Suitable For

Patients who are typically recommended for peripheral artery bypass surgery are those with peripheral artery disease who have not responded to lifestyle changes, best medical treatment, and supervised exercise therapy. Bypass surgery is often recommended for patients with longer and more complex femoropopliteal lesions that cannot be effectively treated with endovascular alternatives such as balloon angioplasty, stents, drug-coated balloons, or atherectomy. Patients with disabling intermittent claudication or critical limb ischemia may also be candidates for peripheral artery bypass surgery. However, it is important to note that bypass surgery is associated with substantial risks and should be carefully considered in each individual case.

Timeline

  • Before peripheral artery bypass:
  1. Patient experiences symptoms of peripheral artery disease such as leg pain, numbness, weakness, or skin discoloration.
  2. Patient undergoes diagnostic tests such as ankle-brachial index (ABI) measurement, ultrasound, or angiography to confirm the presence and severity of arterial blockages.
  3. Patient may undergo conservative treatments such as lifestyle changes, medication, and supervised exercise therapy to improve symptoms and blood flow to the affected limb.
  4. If conservative treatments are not effective, patient may be recommended for peripheral artery bypass surgery.
  • After peripheral artery bypass:
  1. Patient undergoes surgical procedure to create a bypass around the blocked artery using a graft or vein from another part of the body.
  2. Patient may experience post-operative pain, swelling, and discomfort, which can be managed with pain medication and rest.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and mobility in the affected limb.
  4. Patient is monitored closely for any complications such as infection, graft failure, or blood clots.
  5. Patient follows up with healthcare provider regularly to ensure the success of the bypass surgery and to prevent further progression of peripheral artery disease.

What to Ask Your Doctor

  1. What are the potential risks and benefits of peripheral artery bypass surgery for my specific condition?
  2. How long is the recovery time after peripheral artery bypass surgery?
  3. What type of anesthesia will be used during the procedure?
  4. Will I need to stay in the hospital after the surgery, and if so, for how long?
  5. What are the potential complications or side effects of peripheral artery bypass surgery?
  6. Will I need to make any changes to my lifestyle or take any medications after the surgery?
  7. How long can I expect the results of the surgery to last?
  8. Are there any alternative treatment options for my condition?
  9. What is the success rate of peripheral artery bypass surgery for patients with similar conditions?
  10. How frequently will I need follow-up appointments or tests after the surgery?

Reference

Authors: van der Vijver-Coppen RJ, ’t Mannetje YW, Menting TP, Lardenoije JW, Reijnen MP. Journal: J Cardiovasc Surg (Torino). 2018 Apr;59(2):158-163. doi: 10.23736/S0021-9509.18.10374-0. Epub 2018 Jan 9. PMID: 29327573