Bypass Surgery of Extremities

Sometimes called Peripheral Vascular Disease (PVD) or "hardening of the arteries," this is a disease of the peripheral blood vessels that is characterized by narrowing and hardening of the arteries that supply the legs and feet. A decrease in blood flow results.

Arteriosclerosis, "hardening of the arteries" commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on plain X-rays.

It is a common disorder usually affecting men over 50 years old. Twenty percent of people over age 64 will suffer from arteriosclerosis of the extremities.

Persons are at higher risk if they have a personal or family history of coronary artery or cerebrovascular disease, diabetes, smoking, hypertension, or kidney disease involving hemodialysis.

Often, symptoms affect one limb. If arteriosclerosis exists in both limbs, the intensity is usually different.

Symptoms may include:
Leg pain (intermittent claudication)
Occurs with exercise (such as walking)
Relieved with rest
Numbness of the legs or feet at rest
Cold legs or feet
Muscle pain in the thighs, calves or feet
Loss of hair on the lower extremities
Change of color of the legs
Paleness or blueness (cyanosis)
Pulse, weak or absent in the extremity
Walking/gait abnormalities may occur

An examination may show arterial bruits (whooshing sound heard with the stethoscope over the artery), decreased or absent pulse in the extremities, or decreased blood pressure in the affected extremity. A lipid profile may show hyperlipidemia (lipid serum is increased, total cholesterol is increased).

Peripheral artery disease may be revealed by:
An abnormal ratio between the systolic pressure of the ankle and arm (ankle/brachial index, or ABI)
A Doppler ultrasound exam of an extremity
Angiography of the arteries in the legs (arteriography)
Intravascular ultrasound (IVUS) of the extremity
An MRI scan

Medications may be required to control the disorder, including analgesics to control pain, pentoxifylline (in some cases), and medications such as vasodilators or antiplatelet agents.

Surgery is usually performed only on severe cases where the ability to work or pursue essential activities is affected. This may consist of surgical removing of the lining of the artery (endarterectomy), repair or replacement of the vessel (grafting), or most commonly, bypass surgery using a vein or synthetic graft.

Alternatives to surgery may include treatments such as balloon angioplasty (a similar technique to that used to open the coronary arteries, but performed on the blood vessels of the affected extremity), sometimes followed by stent implantation, laser, or other treatments.

Arteriosclerosis of the extremities is usually controllable with treatment. Surgery provides good relief of symptoms.

During surgery the doctor uses veins and an artery to bypass the blocked arteries. These are used as the alternate vessels to deliver blood below the point of the blockage. The surgery reroutes the blood flow to supply areas not receiving enough blood.

The risk of future blockages can be reduced by following guidelines which the doctors give you such as no smoking, avoidance of salt, maintaince of a low cholesterol diet, control of blood pressure and regular exercise.

  A. General Surgery
    1. Laparoscopic Surgery
      a. Exploratory
      b. Appendix
      c. Hernia
      d. Gallbladder
      e. Colon
      f. Hiatal Hernia
    2. Conventional Surgeries
      a. Hernia Repair
      b. Colon
      c. Stomach
      d. Appendix
      e. Thyroid
      f. Soft Tissue Masses and Skin Lesions

  B. Vascular Surgery
    1. Repair of abdominal aortic aneurysm (AAA)
    2. Bypass surgery of extremities
    3. Carotid endarterectomy (CEA)
    4. Creation of arterio-venous fistulas
    5. Placement of central lines

  C. Varicose Vein Treatment
    1. TIPPS (Trans-Illuminated Powered Phlebectomy)
    2. SEPS (Subfascial Endoscopic Perforator Surgery)
    3. Deep venous thrombosis

  D. Breast Disease Management
    1. Evaluation of breast lumps (solid or cystic)
    2. Cyst aspirations
    3. Fine-needle aspiration of solid breast lump
    4. Stereotactic breast biopsy
    5. Sentinel lymph node biopsy
    6. Conventional biopsy
    7. Lumpectomy
    8. Mastectomy

  E. Gastric Bypass (Bariatric Surgery)

  F. Wound Management and Treatment

  G. Thoracic surgery
    1. Chest tube placement
    2. Removal and biopsy of nodules in lung and mediastinum
    3. Lobectomy

  H. Vascular Laboratory

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