Aortoiliac and Aortofemoral Bypass Graft Surgery
(Aortobifemoral Bypass)
Definition
Aortoliac and aortofemoral bypass graft surgery is to bypass a blocked artery. In this case, the aorta, and the iliac or femoral arteries are involved.
The aorta is the body's largest artery. It carries blood from the heart to the rest of the body. At the belly button level, the aorta divides into two iliac arteries. At the groin level, the iliac arteries become the femoral arteries.
Artificial grafts create a path so that blood can move around the blockage.
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Reasons for Procedure
This surgery is done to improve blood flow in the lower part of the body. Atherosclerosis is a major cause of poor blood flow. It causes blood vessels to become narrow and blocked.
In a bypass, tubes (grafts) are placed near a piece of blocked or narrowed blood vessel. Blood can then move through the graft around the blockage.
Possible Complications
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen such as::
- Excess bleeding
- Problems from anesthesia
- Infection
- Blood clots
- Injury to nearby structures or organs
Things that may raise the risk of problems are:
What to Expect
Prior to Procedure
The surgical team may meet with you to talk about:
- Anesthesia options
- Any allergies you may have
- Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
- Fasting before surgery, such as avoiding food or drink after midnight the night before
- Whether you need a ride to and from surgery .
Anesthesia
- The doctor will give general anesthesia. You will be asleep.
- Epidural anesthesia may be added. It will numb your body from the chest down.
Description of the Procedure
Most bypass surgery involves a traditional, open incision. Laparoscopic techniques use much smaller incisions.
A large incision will be made in the abdomen. The muscles around the abdomen will be cut. To get to the blood vessels, some organs will be carefully moved out of the way.
Clamps will be placed on either side of the blocked area. This will briefly 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 check for good blood flow through the graft. Organs will be put back in place. The abdominal muscles will be pulled together and stitched closed. The skin incision will be closed with sutures or staples. A bandage will be placed over the site.
How Long Will It Take?
About 3 to 4 hours
Will It Hurt?
There will be some pain and discomfort after the procedure. Medicine and home care help.
Average Hospital Stay
The usual length of stay is 5 to 7 days. If there are any problems, the stay will be longer.
Post-procedure Care
At the Hospital
After surgery, the staff may:
- Give you medicines to control pain, nausea, and prevent blood clots
- Place a tube through the nose into the stomach—to remove secretions and provide nutrition as the intestines get back to normal
During your stay, the hospital staff will take steps to lower your risk of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to lower your risk of infection such as:
- Washing your hands often and reminding visitors and staff to do the same
- Reminding staff to wear gloves or masks
- Not letting others touch your incisions
At Home
Recovery can take up to 6 weeks. Physical therapy may be needed to maintain or rebuild strength.
Call Your Doctor
Call your doctor if you are not getting better or you have:
- Signs of infection, such as fever or chills
- Redness, swelling, excess bleeding, or discharge from the incision site
- Lasting nausea or vomiting
- Pain that you cannot control with medicine
- Problems passing urine, or blood in urine
- A cough, problems breathing, or chest pain
- A leg that turns cold, pale, blue, tingly, or numb
- Pain or swelling in the legs, calves, or feet
If you think you have an emergency, call for medical help right away.
RESOURCES:
American Heart Association
http://www.heart.org
Society for Vascular Surgery
https://vascular.org
CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca
ICES—Institute for Clinical Evaluative Sciences
https://www.ices.on.ca
REFERENCES:
Aortofemoral bypass surgery. UCSF Department of Surgery website. Available at: https://vascular.surgery.ucsf.edu/conditions--procedures/aortofemoral-bypass-surgery.aspx. Accessed August 27, 2021.
Peripheral artery disease of the lower extremities. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/peripheral-artery-disease-pad-of-lower-extremities. Accessed August 27, 2021.
Sharma G, Scully RE, et al. Thirty-year trends in aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg. 2018;68(6):1796-1804.
Surgical bypass for aortoiliac occlusive disease. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/surgical-bypass-aortoiliac-occlusive-disease. Accessed August 27, 2021.
Last reviewed July 2021 by EBSCO Medical Review Board Nicole Meregian, PA Last Updated: 8/27/2021