Procedures

Lower extremity (leg) bypass

• Description
• Risks
• Pre operative information
• Information about the day of surgery

• Length of recovery
• Post operative information
• References

Description:

A lower extremity bypass operation is designed to “bypass” an area of blockage in an artery to improve blood flow and relieve symptoms. The operation is usually performed with general anesthesia. The bypass often originates from the groin and may extend to the region of the knee or calf. The bypass can be constructed with leg vein or with synthetic material. Often, an angiogram is performed at the conclusion of the operation.

Risks:

Any operation or procedure involves some risks and hazards. The more common risks include: infection, bleeding, nerve injury, blood clots, heart attack, allergic reactions, and pneumonia. These risks can be serious and possibly fatal. The significant risks of this procedure are:
Thrombosis, chronic pain, amputation, graft failure, graft narrowing, failure to relieve pain, failure to heal wounds.

Pre operative information:

Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray.Often, an ultrasound of the leg will be performed to investigate whether the leg vein is usable for bypass.
You will also meet with an anesthesiologist.

Information about the day of surgery:

No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:

Hospitalization ranges from two to four days, depending on the extent of the operation. Inpatient and outpatient physical therapy is often helpful. Complete recovery and return to usual activity may require 6-8 weeks.Upon discharge, you should begin a daily walking schedule that includes a gradual increase in activity. Your diet should consist of foods that are easily tolerated normally. You may return to driving when you no longer require prescription strength (narcotic) pain medications and can easily react to usual driving conditions.

Post operative information:

Femoral-Popliteal Bypass Post-Surgery Guide

The following information is intended to guide you through your post-op recovery:

Diet:

For the first few days after your return home you should eat foods that you easily tolerate normally.

Medications:

Follow the directions on any new prescriptions that your doctor has given you. You may return to taking your regularly scheduled medications on the day of your surgery, unless your doctor has directed you otherwise.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.

PLEASE NOTE:

No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 noon on Friday.
Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:

To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care:

You will likely go home from the hospital with staples or sutures in place. They will usually be removed 1- 2 weeks after your surgery. You will need to make an appointment to come to the office for that.
You may leave a dry gauze dressing over your incision, if your clothes irritate the incision or if you have some drainage from the incision.
It is normal to have a firm lump directly beneath your incision line. This will disappear within a couple of months.
You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision.

Physical activity/Exercise:

Upon your return home you should begin a daily walking program that will build from walking inside your home to walking around your neighborhood. Every patient will have to individualize their walking according to their general health status.
Please elevate your leg(s) whenever you are sitting or resting. This will help control the swelling that you will have after your surgery. Prop your foot up as high as you comfortably can, but not so high that you are experiencing numbness or increased pain.
You may resume sexual activity when it is comfortable to do so.

Bathing and Showering:

You may shower after you remove your dressing which will be 48 hours post-surgery. You may shower with your steri-strips in place. Do not scrub across your steri-strips. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

Your doctor should inform you of when you might return to work after your surgery.

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 2-3 weeks after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.

References: