Bypass vessels of the lower extremities: indications, consequences

Vascular diseases are found in both women and men. More often pathologies affect people of middle and old age. Vascular disease is less common in young people. In some cases, such pathologies are congenital. Typical localization of lesions of the vascular system are coronary, cerebral arteries, veins of the rectum and lower extremities. However, with systemic vasculitis, the process can be spread throughout the body. One of the common reasons for contacting a surgeon is varicose veins. This pathology often occurs in women. The characteristic symptoms are: tortuosity of the veins, their expansion, protrusion. Atherosclerosis is another vascular disease. It leads to clogged arteries and impaired blood patency. In advanced cases, with both pathologies, vessels of the lower extremities are bypassed. This is a surgical operation, thanks to which the blood flow can be completely restored.

For what purpose do leg vessels undergo shunting?

A compulsory measure for diseases of veins and arteries is bypass vessels of the lower extremities. Treatment at the initial stages is carried out conservatively. Patients suffering from atherosclerotic lesions are prescribed lipid-lowering drugs (Atorvastatin, Fenofibrat medicines), and a diet. With varicose veins, wearing special elastic underwear, sclerotherapy is recommended. Shunting of vessels of the lower extremities is carried out with a pronounced blockage of the lumen of an artery or vein, a high risk of thrombosis and the development of gangrene. This procedure is a surgical intervention, it must be performed by an angiosurgeon. Bypass surgery is the replacement of a portion of a vessel with an implant. As a result, the blood supply is restored, and the risk of thrombosis is significantly reduced. The shunt can be made of artificial materials or patient’s own tissues. Often adjacent vessels of the lower extremities are used as an implant. The choice of material depends on the diameter of the damaged artery or vein, as well as on the characteristics of the pathology.

Indications for bypass vessels of the lower extremities

Surgery to bypass vessels of the lower extremities is carried out in a specialized or surgical department of the hospital. It refers to difficult procedures, therefore, it should be performed only according to strict indications. It is worth resorting to bypass vessels if more than 50% of the diameter of the artery or vein is obturated. Before deciding on an operation, doctors prescribe a conservative treatment. Surgical intervention is performed in the absence of the effect of the therapy. The following indications for shunting of vessels of the lower extremities are distinguished:

1. Arteriosclerosis obliterans arteries.
2. Marked pathologies of the venous system. More often with varicose veins and threats of thrombophlebitis, stenting or angioplasty is performed. If there are contraindications to such methods of treatment, vessels are bypassed.
3. Endarteritis. With this pathology, the inflammatory reaction is combined with progressive obliteration of small vessels. Gradually, the arteries become completely clogged, leading to gangrene of the foot. This disease is more common among the male population.
4. Aneurysm of the arteries of the lower extremities. Pathology is dangerous with a high risk of bleeding, which is extremely difficult to stop.

In some cases, vessels of the lower extremities are bypassed with gangrene of the toes or feet. The prognosis for this surgical intervention is not always favorable and depends on the area of ​​necrosis and the individual characteristics of the body. In some cases, the operation leads to the healing of gangrene or a decrease in the size of the affected focus.

In what situations is bypass contraindicated?

Despite the effectiveness of vascular bypass surgery, it is worth remembering that such an operation is very serious. Therefore, it is performed only in cases where other treatment methods do not help. There are a number of contraindications for bypass surgery. Among them:

1. Hypertension not controlled by antihypertensive drugs. In this case, vascular surgery can lead to cardiogenic shock, myocardial infarction, or stroke.
2. Decompensated heart failure, accompanied by edematous syndrome and persistent dyspnea.
3. Unstable angina pectoris.
4. Acute heart failure and myocardial infarction.
5. Aneurysm of the aorta, cerebral vessels.
6. Paroxysmal heart rhythm disturbances.

Shunting of vessels of the lower extremities cannot be carried out in case of infectious diseases, damage to the skin, decompensation of diabetes mellitus. In these cases, the operation is performed after stabilization of the patient's condition.

Shunting Techniques

Most often, artery bypass surgery is performed. This is due to the fact that such pathologies are more common. In addition, with venous damage, other treatment methods are recommended. Among them are balloon angioplasty and stenting. As a shunt to restore arterial blood flow, use the saphenous vein of the thigh. With a large lesion area or unsatisfactory condition of the vessels, synthetic implants are used. There are several techniques for the operation. Among them:

1. Aorto-bifemoral bypass surgery. Surgical intervention is performed at the level of the inguinal region. The essence of the operation is to create a bypass anastomosis between the abdominal part of the aorta and the femoral arteries.
2. Femoral popliteal bypass surgery. An anastomosis is formed between two large arteries of the lower limb. The shunt originates at the base of the thigh and is brought to the area of ​​the knee joint (below or above the joint).
3. Cross bypass Anastomosis passes between the two femoral arteries (from the right leg to the left lower limb, or vice versa).
4. Femorotibial shunting. A vascular graft connects the femoral and tibial arteries.

Preparing the patient for vascular bypass surgery

Preparation for bypass surgery includes a number of diagnostic procedures, as well as the use of drugs. Before the operation, it is necessary to undergo a laboratory examination: OAA, OAM, biochemical blood test, coagulogram. Dopplerography of the vessels of the lower extremities, ECG, echocardiography is also performed. To avoid blood clots during surgery, blood thinners are prescribed a week before. These include medicines "Aspirin Cardio", "Magnikor." Antibiotics and anti-inflammatory drugs are also prescribed. In the evening, on the eve of the operation, it is necessary to stop taking water and food.

Technique for bypass vessels of the lower extremities

Bypassing the vessels of the lower extremities is a complex operation, which requires the high professionalism of the surgeon. Manipulation is performed under general anesthesia. The incision of the skin and underlying tissues is carried out in 2 places - above and below the affected area of ​​the artery. Clamps are applied to the vessel to prevent bleeding. After assessing the affected area, an incision is made on the vessel and the shunt is fixed on one side. Next, a vascular flap is fixed between the muscles and tendons. Thus, the shunt is gradually brought to the place of the second incision (above the lesion) and its end is fixed. After that, the surgeon assesses the state of blood flow. When conducting a successful operation, the artery begins to pulsate. In some cases, instrumental examination methods are performed. The final step in surgery is suturing of deep tissue and skin.

How is the postoperative period?

Inpatient monitoring of the patient who underwent surgery is very important. Especially if this manipulation is bypassing the vessels of the lower extremities. The postoperative period with successful treatment is about 2 weeks. On the 7-10th day, the surgeon removes the stitches. While the patient is in the hospital, it is necessary to perform diagnostic procedures to assess the effectiveness of treatment. In addition, the doctor must make sure that there are no postoperative complications. Already in the first days after surgery, it is recommended to stand up. In the sitting and lying position, the lower limbs must be fixed in an elevated state.

Recovery Recommendations

After shunting of the vessels of the lower extremities, it is necessary to monitor the state of blood flow. To this end, the patient should be periodically examined (ultrasound and Doppler ultrasound). Also recommended:

1. Stop smoking.
2. Take antiplatelet drugs to prevent thrombosis.
3. Keep track of body weight. With an increase in BMI, a lipid-lowering diet and drug treatment are prescribed.
4. Take daily walks.
5. Wear special stockings (socks) and shoes.

Vascular bypass surgery of the lower extremities: patient reviews

Reviews of patients who underwent surgery are mostly positive. Patients noted a decrease in pain, numbness in the legs. However, in a number of cases, people complain of the recurrence of symptoms after some time. This is due to damage to neighboring arteries and veins. It is worth remembering that bypass surgery is not a treatment for atherosclerosis, and the cause of vascular damage does not disappear after surgery. Therefore, in order to avoid thrombosis and the development of gangrene, it is important to observe preventive measures.

Bypass vessels of the lower extremities: complications of the operation

The complications of the operation include the formation of a blood clot in a shunt, the development of acute heart failure, pulmonary embolism. In the recovery period, suppuration of the wound in the suture area and bleeding from it is possible. Despite the fact that the operation is considered complex and lengthy (up to 3 hours), complications are rare. The frequency of their development is about 2%.