Aortobifemoral Bypass

The procedure for an aortobifemoral bypass is as follows:

1. Your doctor may require that you stop taking some medications prior to this surgery, especially those that affect the clotting of your blood.
2. Your doctor may require that you stop smoking prior to the surgery to reduce possible complications.
3. You will be put under general anesthesia.
4. Your doctor will make an incision in your abdomen.
5. Another incision will be made in your groin area.
6. A fabric tube shaped in a Y will be used as the graft.
7. The single end of the Y-shaped tube will be connected to the artery in your abdomen.
8. The opposing two ends of the tube will be connected to the two femoral arteries in your legs.
9. The ends of the tube, or graft, will be sewn into the arteries.
10. The blood flow will be redirected into the graft.
11. The blood will flow through the graft and go around, or bypass, the area of the blockage.
12. Blood flow will be restored to your legs.
13. Your doctor will then close the incisions and you will be taken to recovery.

Here is a standard recovery timeline following an aortobifemoral bypass:

• You will remain in bed for 12 hours immediately following the procedure.
• The bladder catheter will stay in until you are mobile — usually after one day.
• You will stay in the hospital for four to seven days.
• The pulses in your legs will be checked hourly to verify that the grafts are working properly.
• You will be given pain medication as needed.
• Once released, you will be allowed to return home.
• You will gradually increase the amount of time and distance that you walk each day.
• Your legs should be raised when you are in a seated position (i.e., placed on a chair, sofa, ottoman, or stool).

An aortobifemoral bypass is done when the large blood vessels in your abdomen, groin, or pelvis are blocked. These large blood vessels may be the aorta, and femoral or iliac arteries. The blood vessel blockage allows no, or very little, blood to pass into your leg or legs.

This surgical procedure is usually only done if you are in danger of losing your limb or if you are having serious or significant symptoms. These symptoms may include:

• leg aches
• pain in the legs
• legs that feel heavy

These symptoms are considered serious enough for this procedure if they occur when you walk as well as when you are at rest. You could also need the procedure if your symptoms make it difficult to complete basic daily tasks, you have an infection in your affected leg, or your symptoms don’t improve with other treatments.

Conditions that may cause this type of blockage are:

• peripheral arterial disease (PAD)
• aortoiliac disease
• blocked or severely narrowed arteries

Aortobifemoral bypass is the best option for a blockage that restricts blood flow to the femoral artery. However, there’s another procedure called an axillobifemoral bypass that may be used in some cases.

The axillobifemoral bypass puts less stress on your heart during the surgery. It also doesn’t require your abdomen to be opened during surgery. This is because it uses a plastic tube graft and connects the femoral arteries in your legs with the axillary artery in your shoulder. However, the graft used in this procedure is at greater risk of blockage, infection, and other complications because it travels a greater distance and because the axillary artery is not as large as your aorta. The reason for this increased risk of complications is due to the graft not being buried as deeply in the tissues and because the graft is narrower in this procedure.

An aortobifemoral bypass is not available for everyone. The anesthesia can cause major complications for those with serious lung conditions. Those with heart conditions may not be eligible for this procedure because it puts a lot of stress on the heart. Smoking can also increase the risk of complications during an aortobifemoral bypass. If you smoke, you should stop prior to this surgery to reduce complications.

The most serious complication of this procedure is heart attack. Your doctor will perform several tests prior to the surgery to ensure you don’t have heart disease or any conditions that could increase your risk of heart attack.

An aortobifemoral bypass has a 3 percent mortality rate, but this can differ based on your individual health and fitness at the time of the surgery.

Other complications that are less serious may include:

• infection in the wound
• graft infection
• bleeding after the operation
• deep vein thrombosis
• sexual dysfunction
• stroke

Eighty percent of aortobifemoral bypass surgeries successfully open the artery and relieve symptoms for 10 years after the procedure. Your pain should be relieved when you are resting. You pain should also be gone or greatly reduced when you are walking. Your outlook is better if you don’t smoke or quit smoking prior to the bypass surgery.