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1. 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 becomes particularly noticeable when your muscles require more blood during walking and causes pain. Any further fall in the flow of blood may lead to constant pain with the risks of ulcers or gangrene developing. This operation is to bypass the blocked arteries in your tummy (abdomen) that supply your legs, so that the blood supply is improved.
2. Before your operation.
You will usually be admitted into hospital one or two days before your operation or you will be asked to attend a pre-admission clinic about a week earlier in order to allow time for tests required to ensure you are fit for your operation. These tests may include scans of the abdomen or x-rays of the arteries (arteriogram) if these have not already been done. Special scans of your heart to check that it is working properly may also be needed.
3. Coming into hospital.
Please bring with you all the medications that you are currently taking. You will be admitted to your bed by one of the nurses who will also note down your personal details in your nursing records. Prior to surgery you will undergo a number of investigations, if these have not been performed previously, including a heart tracing, a chest x-ray and blood tests. You will be visited by a member of the surgical team who will be performing your operation and also the doctor who will give you the anaesthetic. If you have any questions regarding the operation please ask the doctors.
4. The operation.
You will be taken initially to a reception area in the theatre suite, then to the anaesthetic room where you will be given your anaesthetic, and from there into the theatre. As well as being put to sleep you may have a small tube placed in your back to help with pain relief following surgery (epidural). Whilst you are asleep tubes will also be inserted into your bladder to drain your urine, into your stomach (via your nose) to stop you feeling sick, and into a vein in your neck for blood pressure measurements and administration of fluid following surgery. You will usually have a long cut down or across your tummy (abdomen) and also two smaller cuts, one in each groin. An artificial blood vessel (graft) made of plastic will be inserted to carry blood from the main blood vessel in your abdomen (aorta) to the arteries in your groins, bypassing the blocked arteries, (aortobifemoral graft).
If there are particular problems with your chest or heart, your surgeon may decide to avoid a cut in your abdomen. In this case you will have a cut below one of your collar bones, and a vertical cut in each groin. An artificial blood vessel made of plastic shaped like an upside down Y will be tunnelled under the skin between these incisions and will be attached to the main blood vessel supplying one arm and to the main blood vessel supplying each leg, (axillobifemoral graft). Your arm can easily spare the blood required by your legs through this bypass. The wounds are often closed with a stitch under the skin or with clips that need to be removed.
5. After the operation.
You will usually be taken to an intensive care or high dependency unit following your operation in order to be able to monitor your progress closely. It is sometimes necessary for you to remain on a breathing machine for a 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 may also be required.
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