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Date issued: December 2023

Review date: December 2025

Ref: A-596/JW/Cardiology/Aortobifemoral / Axillobifemoral Bypass v3

PDF:  Aortobifemoral / Axillobifemoral Bypass Graft.pdf[pdf] 126KB

Why do I need the operation?

Because you have a blockage or narrowing of the arteries supplying your legs, the circulation to your legs is reduced. This operation is to bypass the blocked arteries in your pelvis that supply your legs, so that the blood supply is improved.

What does the operation involve?

Aortobifemoral Surgery:

You will have a cut, either down or across your tummy and also two smaller cuts, one in each groin.

An artificial graft made of sterile plastic will then be inserted to carry blood from the main blood vessel in your abdomen (aorta) to the arteries in your groins, thus bypassing the blocked arteries.

The wounds are closed with either a stitch under the skin that dissolves or by clips or stitches that will need to be removed about 10 days after the surgery.

Axillobifemoral Surgery:

This usually performed if there are problems with your heart or lungs as it is a lower risk operation than above. Instead of a cut across your tummy, your surgeon will make a cut below one of your collar bones and one in each groin, and then an artificial graft shaped like a upside Y, will be inserted to bypass the blocked arteries.

After the Operation

You will usually spend 1-2 days in the Intensive Care or High Dependency Unit after your operation so that we can monitor your progress closely.

It may be necessary for you to remain on a breathing machine for a short period after the operation, but you will be taken off this as soon as possible.

Following this sort of surgery, the bowel stops working for a while and you will be given all the fluids you require in a drip until your bowel will cope with fluids by mouth.

A blood transfusion is sometimes required.

The nurses and doctors will assist in controlling your pain by giving painkillers.

As the days pass and you start to recover, the various tubes will be removed, and you will remain in hospital until you are fit enough to go home (usually 7-10 days after the operation).

Going Home

If your stitches or clips are the type that needs removing, we will arrange for your GP practice or district nurse to remove them and check your wound.

You will feel tired for many weeks after the operation but this will improve as time goes by.

Regular exercise such as a short walk combined with rest is recommended for the first few weeks followed by a gradual return to normal activity.

Driving: You will be able to drive when you can perform an emergency stop safely. This will normally be 6 weeks after surgery, but if in doubt, check with your own doctor.

Bathing: Once your wound is dry, you may bathe or shower as normal. This will normally be before you leave hospital.

Work: You should be able to return to work within 6-12 weeks of surgery. We will provide you with a sick note but if you need longer off work, please see your GP.

Lifting: You should avoid heavy lifting or straining for 6 weeks after the operation.

Medicines: You will usually be sent home on a small dose of aspirin if you were not already taking it. This makes the blood less sticky. If you are allergic to aspirin, or if it upsets your stomach, an alternative drug may be prescribed.

Complications

Chest infections (Common) These can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.

Wound infection (Uncommon) Wounds sometimes become infected and this may need treatment with antibiotics. Bad infections are rare.

Graft infection (Very rare) the Dacron graft may become infected. This is a serious complication, and usually treatment involves removal of the graft.

Fluid leak from wound (Common) the wound in your groin can fill with a fluid called lymph that may leak between the stitches. This usually settles down with time.

Bowel problems (Common) Occasionally the bowel is slow to start working again after the operation. This requires patience and fluids will be provided via a drip until your bowels get back to normal.

Sexual activity (Impotence) This may occur in men due to nerves in your tummy being unavoidably cut during the operation. This occurs in about 30% of patients.

Major Complications (Rare) As with any major operation there is a small risk of you having a medical complication such as a heart attack, stroke, kidney failure, chest problems, loss of circulation in the legs or bowel or infection in the artificial artery.

Who to contact If I have any concerns?

Less than 24 hours post discharge:

Call 01752 202082 and ask for the ward you were discharged from.

After 24 hours post discharge:

Urgent Medical Help: 11 or 999

Pain/ medication concerns: GP

Operation specific questions: Consultant’s Secretary or Vascular Specialist Nurse

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Nurse Specialist

Mr Alan Elstone

Miss Jess Webster

01752 431805

What can I do to help myself?

• Quit Smoking

• Lower Cholesterol

• Keep active

• Control blood sugar levels in diabetes

• Maintain a healthy diet

• Maintain a healthy blood pressure

The nurse looking after you will be able to give you information/resources for any of these that are relevant to you.