We have established that there is a narrowing or clogging in one of the arteries of your leg. This defect is the result of a build-up of fat deposits and hardening of the wall of the artery. This is called atherosclerosis. Due to this, the skin and/or the muscles in your leg do not receive sufficient oxygen. In the case of narrowed or clogged arteries in the leg, surgery can be performed. The doctor treating you has suggested a bypass operation. This leaflet will provide you with information about the disorder, the operation and the risks involved.
What are the possible causes of atherosclerosis?
- High blood pressure
- High cholesterol
- High level of fatty acids in the blood.
Which are the symptoms?
- Serious pain in the calf (calves) and/or upper legs when walking (intermittent claudication).
- Slowly-healing wounds on the feet and, in serious cases, necrosis of one or more toes.
Who will perform your surgery?
You will be operated on by the surgeon you saw at the outpatient clinic, a fellow surgeon or a physician assistant. A physician assistant is a graduate physician who we train at HMC to become a specialist or who is working at our hospital to gain experience. Physician assistants also perform (sections of) operations independently. The medical specialist is always ultimately responsible for the surgery. By using different doctors, we can plan the operations better and keep the waiting times as short as possible. If you would prefer to be operated on by the doctor you saw at the outpatient clinic, please let the doctor or the Admissions Office know.
During the operation a bypass is made which diverts the blood around the clogged part. The bypass is connected to the healthy arteries in your leg above and below the clogged part. In this way sufficient blood will reach the muscles of your lower legs. The vascular surgeon will make one or more wounds (incisions) in your leg for this purpose. The bypass is normally made from a person’s own artery in the leg which is located under the skin and which can be removed without causing problems. If it is not possible to use such an artery, an artificial artery will be used.
The operation is done under full anaesthesia or by means of local anaesthesia through an epidural. The anaesthesiologist will discuss this with you prior to the operation.
How long will the operation last?
The operation will last between 2 and 3 hours.
After the operation
After the operation your leg will be checked regularly, in particular to see whether the bypass is properly functioning and to make sure that there is no subsequent bleeding.
If an epidural is used, you might have temporary problems urinating. If you are not able to urinate spontaneously, a temporary urine catheter will be inserted.
Depending on the way the wound is healing, you will have to remain in hospital between 5 and 10 days.
After the operation an anticoagulant will be prescribed to you in order to minimize the chances that the bypass will become clogged. In principle, you will have to take this medication for the rest of your life.
Near to the scar there might be spots where there is a loss of feeling. This feeling often comes back slowly, sometimes only partially. It is also possible that, for several months, your leg will feel thick and heavy. After this
operation, it might take several weeks before you have fully recovered your strength. It is important to avoid all causes of atherosclerosis, therefore:
- Do not smoke
- Eat healthy food
- Make sure you get plenty of physical exercise
- Make sure high blood pressure, high cholesterol and diabetes are properly treated. Most probably, you have already made an appointment about this with your GP (family doctor) practitioner or your internist.
In spite of complying with the above rules, it is possible that in the long run, mostly after many years, the bypass will close again. You will note this because you will, once again, feel the same symptoms as the ones you had before the operation. If this happens, you should contact your GP or the hospital.
There is not a single operation that precludes the possibility of complications. Also after having undergone this operation, there is a slight chance of general complications such as infection of the wound, inflammation of the bladder, pneumonia, coronary attack, a thrombosis of the leg or a pulmonary embolism.
Specific complications might include:
Subsequent bleeding at the location where the bypass is connected to your own artery, closing of the bypass or closing of a minor artery in your lower leg or foot due to a detached embolism. However, the chance that these specific complications occur is minimal. If one of these complications happens, a new operation might be necessary.
If after having read this leaflet you still have questions, please do not hesitate to contact the surgeon treating you to ask these questions.
The Outpatients’ Surgery Department may be reached through phone number: +31 (0)88 979 43 59. (on workdays from 08.00 - 17.00 hours).