Our Summary

This study looked at two different ways of performing a type of surgery called an infrainguinal bypass, which is often used to treat blocked arteries in the legs. The researchers were specifically interested in where the best place to connect the bypass (known as the ‘proximal anastomosis’) is.

One option is to connect the bypass to a previous bypass ‘hood’ (a type of graft), which can be easier to do during surgery. The other option is to connect it to the patient’s own artery further down the leg, which might help to keep the bypass open for longer.

The team looked at a database of surgeries performed by one group of vascular surgeons between 2006 and 2016. They studied 197 cases where an infrainguinal bypass was performed after a previous bypass to a certain artery in the leg (the femoral artery). They then compared surgeries where the bypass was connected to the previous bypass hood with those where it was connected to the patient’s own artery.

The researchers found that the patient’s own artery was the better option. One year after surgery, the bypass was still open in 91% of these cases, compared to 75% of those connected to the previous bypass hood. If the previous bypass became blocked, the patient’s own artery was still the better option - the bypass stayed open in 87% of these cases, compared to just 40% of those connected to the previous bypass hood.

In conclusion, the study suggests that using a patient’s own artery for infrainguinal bypass surgery may provide better long-term results.

FAQs

  1. What is an infrainguinal bypass?
  2. What are the two options for connecting the bypass during an infrainguinal bypass surgery?
  3. According to this study, which option for connecting the bypass during the surgery provides better long-term results?

Doctor’s Tip

A helpful tip a doctor might tell a patient about peripheral artery bypass is to consider connecting the bypass to the patient’s own artery further down the leg, rather than to a previous bypass hood. This could potentially help keep the bypass open for longer and provide better long-term results. It is important to discuss the best option for your specific case with your healthcare provider.

Suitable For

Patients with blocked arteries in the legs who have previously undergone a bypass to the femoral artery may be recommended for peripheral artery bypass surgery. Specifically, patients who may benefit from this type of surgery include those with peripheral artery disease, chronic limb ischemia, intermittent claudication, or critical limb ischemia. These patients may experience symptoms such as leg pain, cramping, numbness, or weakness due to reduced blood flow to the legs. Ultimately, a vascular surgeon will evaluate each patient’s individual condition and determine if they are a suitable candidate for peripheral artery bypass surgery.

Timeline

Before peripheral artery bypass surgery:

  • Patient experiences symptoms of peripheral artery disease, such as leg pain, numbness, or weakness
  • Patient undergoes diagnostic tests, such as ultrasound or angiography, to determine the extent of blockage in the arteries
  • Treatment options, including medication, lifestyle changes, or minimally invasive procedures, may be considered before surgery is recommended

After peripheral artery bypass surgery:

  • Patient undergoes pre-operative preparation, including fasting and medication adjustments
  • Surgery is performed, where a graft or vein is used to create a new pathway for blood flow around the blocked artery
  • Patient recovers in the hospital for a few days, with monitoring for complications such as infection or blood clots
  • Patient undergoes post-operative rehabilitation, including physical therapy to regain strength and mobility
  • Follow-up appointments and monitoring are scheduled to ensure the success of the bypass and to address any potential complications.

What to Ask Your Doctor

  1. What are the benefits of connecting the bypass to a patient’s own artery compared to a previous bypass hood?
  2. Are there any potential risks or complications associated with connecting the bypass to a patient’s own artery?
  3. How long can I expect the bypass to stay open if it is connected to my own artery versus a previous bypass hood?
  4. Will connecting the bypass to my own artery require a longer or more complex surgery?
  5. How will the choice of proximal anastomosis location affect my recovery and overall outcome?
  6. Are there any specific factors or conditions that would make one option more suitable for me than the other?
  7. Will I need any additional monitoring or follow-up care if the bypass is connected to my own artery?
  8. Can you provide more information about the success rates and potential complications associated with both options based on your experience and expertise?
  9. How will the choice of proximal anastomosis location impact my quality of life and ability to engage in physical activities post-surgery?
  10. Are there any alternative treatment options or considerations that I should be aware of before making a decision about the location of the bypass?

Reference

Authors: Russo NJ, Pokuri S, Yeh CC, Hnath J, Chang BB, Darling RC 3rd. Journal: J Vasc Surg. 2021 Sep;74(3):798-803. doi: 10.1016/j.jvs.2021.02.034. Epub 2021 Mar 5. PMID: 33677029