Aortoiliac and Aortofemoral Bypass Graft Surgery
by Rosalyn Carson-DeWitt, MD
In a bypass, artificial tubes (grafts) are placed near a section of the blood vessel that is blocked or narrowed. The graft creates a path so that blood can move around the blockage. In this case, the grafts are placed on the aorta and the iliac or femoral arteries.
The aorta is the major artery that leaves the heart. It brings oxygen-rich blood to the body. At about the level of the belly button, the aorta divides into two iliac arteries. At the level of the groin, the iliac arteries become the femoral arteries.
Aortofemoral bypass is also called aorto bi femoral bypass. This is because the graft is formed in the shape of an upside down "y."
Most bypass surgery involves a traditional, open incision. Research is being done on how to do these operations through laparoscopic or mini-laparotomy techniques. They use much smaller incisions.
Reasons for Procedure
To have good blood flow to the lower part of the body, there must be good blood flow through the aorta, the iliac arteries, and the femoral arteries. Atherosclerosis is a disease in which sticky patches (plaques) build up along the walls of blood vessels. These plaques block the normal flow of blood within affected blood vessels. When the blood flow is decreased, the tissues on the other side of the blockage do not receive enough oxygen. This can result in the following:
This surgery can restore blood flow to the legs.
Possible Complications TOP
If you are planning to have a bypass, your doctor will review a list of possible complications, which may include:
Factors that may increase the risk of complications include:
What to Expect TOP
Prior to Procedure
Your doctor may do the following:
Leading up to your procedure:
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
General anesthesia is used for this surgery. You will be asleep. A tube will be inserted into your throat to help you breathe.
Sometimes, an epidural anesthesia will be added. This anesthesia is injected into the spinal column. It will numb your body from the chest down.
Description of the Procedure
A large incision will be made in your abdomen. The muscles around your abdomen will be cut. To get to the blood vessels, some organs will need to be carefully moved out of the way.
Blood flow through the vessels will be briefly stopped. Clamps will be placed on either side of the blocked area to stop blood flow. The graft will be sewn into place. One end of the graft will be attached to the aorta just above the blockage. The other end will be attached just after the blockage on the femoral or iliac arteries.
The clamps will be removed. The doctor will watch to make sure there is good blood flow through the graft. Your internal organs will be put back into place. The abdominal muscles will be pulled together. The muscles will be stitched closed. The skin incision will be closed with either sutures or staples.
After the surgery, you will be brought to a recovery room. The tube in your throat may be removed, or it may need to stay in for a few days. The epidural anesthesia may also be continued for a few days. You will be monitored for any adverse reactions to the surgery or anesthesia.
How Long Will It Take?
About 3-4 hours
How Much Will It Hurt?
Anesthesia will block pain during the surgery. The large incision will cause pain after the surgery. You will be given pain medicine to help manage pain.
Average Hospital Stay
The usual length of stay is 5-7 days. The length will depend on your overall health and the speed of your recovery. Your doctor may choose to keep you longer if complications arise.
At the Hospital
You will need to spend 1-2 days in bed after your operation.
After the procedure, be sure to follow your doctor's instructions.
Call Your Doctor TOP
After you leave the hospital, contact your doctor if any of the following occurs:
American Heart Association
Society for Vascular Surgery
Heart and Stroke Foundation of Canada
Institute for Clinical Evaluative Sciences (ICES)
Braunwald E. Zipes DP, Libby P, Bonow R, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 7th ed. St. Louis, MO: WB Saunders Co; 2005.
Townsend CM, Beauchamp DR, Evers MB, Mattox KL, Sabiston DC, eds. Sabiston Textbook of Surgery . 17th ed. St. Louis, MO: WB Saunders Co; 2004.
Last reviewed November 2012 by Michael J. Fucci, DO
Last Updated: 11/26/2012