1. Why do I need the operation?
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| Because you have a blockage or narrowing of the arteries supplying your legs, the circulation to your
legs is reduced. This becomes particularly noticeable when your muscles require more blood during
walking and causes pain. Any further fall in the flow of blood may lead to constant pain with the risks
of ulcers or gangrene developing. This operation is to bypass the blocked arteries in your tummy
(abdomen) that supply your legs, so that the blood supply is improved. |
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2. Before your operation.
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You will usually be admitted into hospital one or two days before your operation or you will be asked to
attend a pre-admission clinic about a week earlier in order to allow time for tests required to
ensure you are fit for your operation. These tests may include scans of the abdomen or x-rays of
the arteries (arteriogram) if these have not already been done. Special scans of your heart to check that it is working properly may also
be needed.
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3. Coming into hospital.
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| Please bring with you all the medications that you are
currently taking. You will be admitted to your bed by one of
the nurses who will also note down your personal details in your
nursing records. Prior to surgery you will undergo a number of
investigations, if these have not been performed previously,
including a heart tracing, a chest x-ray and blood tests. You will
be visited by the Surgeon who will be performing your
operation and also the doctor who will give you the
anaesthetic. If you have any questions regarding the operation
please ask the doctors. |
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4. The operation.
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| You will be taken initially to a reception area in the theatre suite, then to the anaesthetic room
where you will be given your anaesthetic, and from there into the theatre. As well as being put to
sleep you may have a small tube placed in your back to help with pain relief following surgery. Whilst you are asleep tubes will
also be inserted into your bladder to drain your urine, into your stomach (via your nose) to stop you feeling
sick, and into a vein in your neck for blood pressure measurements and administration of fluid following
surgery. You will usually have a long cut down or across your tummy (abdomen) and also two smaller cuts,
one in each groin. An artificial blood vessel (graft) made of plastic will be inserted to carry blood from the
main blood vessel in your abdomen (aorta) to the arteries in your groins, bypassing the blocked arteries,
(aortobifemoral graft). If there are particular problems with your chest or heart, your surgeon may decide to avoid a cut in your
abdomen. In this case you will have a cut below one of your collar bones, and a vertical cut in each groin.
An artificial blood vessel made of plastic shaped like an upside down Y will be tunnelled under the skin
between these incisions and will be attached to the main blood vessel supplying one arm and to the main
blood vessel supplying each leg, (axillobifemoral graft). Your arm can easily spare the blood required by
your legs through this bypass. The wounds are often closed with a stitch under the skin that dissolves by
itself, or with clips that need to be removed. |
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5. After the operation.
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| You will usually be taken to an intensive care or high dependency unit following your operation in order to
be able to monitor your progress closely. It is sometimes necessary for you to remain on a breathing machine
for a period after the operation but you will be taken off this as soon as possible. Following this sort of
surgery the bowel stops working for a while and you will be given all the fluids you require in a drip until
your bowel will cope with fluids by mouth. A blood transfusion may also be required. The nurses and
doctors will try and keep you free of pain by giving pain killers by injection, via a tube in your back
(epidural), or by a machine that you are able to control yourself by pressing a button. As the days pass and
you improve the various tubes will be removed and you will be returned to the normal ward until you are fit
enough to go home. You will be visited by the physiotherapist before and after your operation who will help you with your
breathing to prevent you developing a chest infection and with your walking. |
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6. Going home.
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If dissolvable stitches have been used, these do not need to be removed. If your stitches or clips are the type
that need removing, and this is not done whilst you are still in hospital, the practice or
district nurse will remove them and check your wound. You will feel tired for many weeks after the operation but this should
gradually improve as time goes by. Regular exercise such as a short walk combined with rest is
recommended for the first few weeks following surgery followed by a gradual return to your normal activity.
Driving: You will be safe to drive when you are able to perform an emergency stop. This will normally be
at least 4 weeks after surgery, but if in doubt check with your own doctor.
Bathing: Once your wound is dry you may bathe or shower as normal.
Work: You should be able to return to work within 1-3 months following your operation. If in doubt please
ask your doctor.
Lifting: You should avoid heavy lifting or straining for 6 weeks after the operation.
You will usually be sent home on a small dose of aspirin if you were not already taking it. This is to make
the blood less sticky. If you are unable to tolerate aspirin an alternative drug may be prescribed. |
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7. Complications.
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Chest infections can occur following this type of surgery, particularly in smokers, and may require treatment
with antibiotics and physiotherapy. Slight discomfort and twinges of pain in your wound is normal for several weeks following surgery, but
wounds sometimes become infected and these can usually be successfully be treated with antibiotics. Also
the wound in your groin can fill with a fluid called lymph that may discharge between the stitches but this
usually settles down with time.
As with any major operation such as this there is a very small risk of you having a medical complication
such as a heart attack, but the doctors and nurses will try to prevent these
complications and to deal with them rapidly if they occur. Occasionally the bowel is slow to start working again but this requires patience and fluids will be provided
in a drip until your bowels get back to normal. Sexual activity may be affected due to nerves in your tummy being cut during the operation. |
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8. What can I do to help myself?
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| If you were previously a smoker you must make a sincere and determined effort to stop completely. Continued smoking will cause further damage to your arteries and your graft is more likely to stop working.
General health measures such as reducing weight, a low fat diet and regular exercise are also important. |
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