What is an aortobifemoral bypass?

An aortobifemoral bypass is surgery to redirect blood flow around blocked blood vessels in your belly or groin area. The surgery is done to increase blood flow to the legs. This may relieve symptoms such a leg pain, numbness, and cramping. You may be able to walk longer distances without leg pain.

The doctor will use a man-made blood vessel, called a graft, to bypass the blocked blood vessels. The graft will carry blood from the aorta to the femoral artery in the groin area of each thigh. The aorta is the large blood vessel that carries blood from the heart to the blood vessels in the belly. The femoral arteries are large blood vessels that carry blood from the blood vessels in the belly to the legs.

The doctor will make a cut (incision) in your belly. He or she will also make an incision in the groin area of each upper thigh. The doctor will put the graft in your belly through the incisions. Then he or she will connect the graft to the aorta and the femoral arteries. After the graft is in place, the doctor will close the incisions in your skin with stitches or staples.

You will probably spend 4 to 7 days in the hospital. You will need to take it easy for at least 4 to 6 weeks at home.

What happens before surgery?

Preparing for surgery

• Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
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  Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your surgery.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• You may need to stop taking certain medicines a week or more before surgery, so talk to your doctor as soon as you can.
• Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.
• You may need to empty your bowels with an enema or laxative. Your doctor will tell you if you need to do this.

Taking care of yourself before surgery

• Build healthy habits into your life. Changes are best made several weeks before surgery, since your body may react to sudden changes in your habits.
  • Stay as active as you can.
  • Eat a healthy diet.
  • Cut back or quit alcohol and tobacco.
• If you have an advance care plan, let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before surgery, regardless of the type of surgery or condition.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking, or your surgery may be cancelled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do NOT shave the surgical site yourself.
• Remove all jewellery, piercings, and contact lenses.
• Leave your valuables at home.

At the hospital or surgery centre

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  Bring a picture ID.
• Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery may be marked.
• A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
• You may get an epidural catheter, which is a tiny tube that puts pain medicine into the area in your back around your spinal cord. The epidural will prevent pain after surgery.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 2 to 3 hours.
• You will probably go to the intensive care unit (ICU) after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
• You may have a thin plastic tube in your nose that goes down the back of your throat into your stomach to drain stomach juices. The tube is usually removed 1 to 3 days after surgery.
• As you wake up in the ICU, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.

Going home

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  Be sure you have someone to drive you home.
• For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
• Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
• You will be given more specific instructions about recovering from your surgery, including activity and when you may return to work.