Patient Information on axillo-femoral/axillo-profunda bypass

Who this leaflet is for and its aim

This leaflet is for patients who have been recommended axillo-femoral/axillo-profunda bypass to improve the blood flow in the leg.

This leaflet aims to explain the procedure and its risks.

Background information

An axillo-femoral/axillo profunda bypass is an operation to improve blood flow to the arteries in the leg.

The two main arteries in the leg are the femoral and profunda arteries. If there is a blockage in the iliac arteries that get blood flowing into these two leg arteries an alternative method of getting blood to the leg has to be found.

The most common bypass operations performed are either an axillo-femoral bypass or an axillo-profunda graft bypass. The precise name of your procedure depends on where the bypass starts and finishes. When one of the iliac arteries is blocked, usually due to atherosclerosis (hardening of the arteries), blood flow to the end of the leg is reduced. An X-ray or scan will usually show exactly where the blockage is, enabling treatment to be planned. If the leg is adjusting well to the reduced blood flow, it can be safe to leave the blockage alone, monitor any progress and prescribe some simple medicines to prevent further deterioration. However, the lack of blood flow can cause pain, ulceration and even gangrene in the foot, which will require surgical treatment to improve the blood flow.

A balloon or stent can sometimes be used to open up blocked arteries. If this is not possible a bypass operation is usually required.

The procedure

During the operation a new route for the blood to flow is made to bypass the blockage. The new ‘artery’ is a Y-shaped artificial graft, with one end being sewn onto a blood vessel near the shoulder (axillary artery) and the other two ends sewn onto the blood vessel in each groin. The operation itself involves a cut over each artery and the graft is then pushed under the skin between the cuts on the shoulder and in the groin. This allows the blood to flow around the blockage and into the leg. Typically, this operation takes two to three hours to perform.

During surgery, you may lose blood. If you lose a considerable amount of blood your doctor may want to replace the loss with a blood transfusion as significant blood loss can cause you harm. The blood transfusion can involve giving you other blood components such as plasma and platelets which are necessary for blood clotting. Your doctor will only give you a transfusion of blood or blood components during surgery, or recommend for you to have a transfusion after surgery, if you need it.

Compared to other everyday risks the likelihood of getting a serious side effect from a transfusion of blood or blood component is very low. Your doctor can explain to you the benefits and risks from a blood transfusion. Your doctor can also give you information about whether there are suitable alternatives to blood transfusion for your treatment. There is a patient information leaflet for blood transfusion available for you to read.

After the procedure

Once your surgery is completed you will usually be transferred to the recovery ward where you will be looked after by specially trained nurses, under the direction of your anaesthetist. The nurses will monitor you closely until the effects of any general anaesthetic have adequately worn off and you are conscious. They will monitor your heart rate, blood pressure and oxygen levels too. You may be given oxygen via a facemask, fluids via your drip and appropriate pain relief until you are comfortable enough to return to your ward. You will also have a small plastic tube in the bladder to help you pass urine after the operation. Sometimes, people feel sick after an operation and might vomit. If you feel sick, please tell a nurse and you will be given medicine to stop the sickness/vomiting. Most of the wound drains and drips are removed in the first 48 hours.

After certain major operations you may be transferred to the intensive care unit (ICU/ITU), high dependency unit (HDU), intermediate dependency area (IDA) or fast track/overnight intensive recovery (OIR). These are areas where you will be monitored much more closely because of the nature of your operation or because of certain pre-existing health problems that you may have. If your surgeon or anaesthetist believes you should go to one of these areas after your operation, they will tell you and explain to you what you should expect.

Intended benefits

The purpose of the procedure is to improve blood flow to your leg/foot. This should reduce any pain, help any ulcers heal (and to stop gangrene spreading). If successful, the operation reduces the chances of needing to have an amputation.

Those patients who experienced pain in the calves on walking (claudication) will usually find they can walk further before the pain begins.

Risks

The bypass graft can block and stop working. This occurs early after the operation in one in ten patients. This blockage can be cleared successfully in some cases, but if this is not possible then there is a risk of losing the leg as a result of the operation.

Later on, in the months after the bypass, the graft can also block. Overall about six out of ten of the grafts keep working for three to five years.

Other complications that are specific to this surgery are:

• bleeding from the graft
• infection of the wounds and/or graft
• deep vein thrombosis (DVT) in the leg.

These occur in one out of 20 patients. Infection of the graft is difficult to treat and often ends with the graft being removed and if this happens there is a risk of amputation.

More general complications related to the anaesthetic and the stress of surgery include:

• pneumonia (chest infection)
• myocardial infarction (heart attack)
• major organ failure (for example, heart, kidney, lung): these affect approximately
• 1 in 20 patients.

The operation does carry some serious risks and there is approximately a one in twenty-five chance of dying from the operation. This figure will vary depending on the patient’s health prior to the operation.

Alternatives

Surgery is usually only undertaken when other non-surgical and X-ray based treatments have not succeeded or are not possible. The decision is then taken to either undertake surgery now or monitor the leg to see if it gradually improves on its own. Some limited improvement usually occurs on its own in about a third of cases.

If the leg deteriorates further, then amputation might be necessary.

Information and support

We may give you additional patient information before or after the procedure, for example, leaflets that explain what to do after the procedure and what problems to look out for. If you have any questions or anxieties, please feel free to ask a member of staff or our Vascular Specialist Nurses on 01223 348526.

Further information is available from The Vascular Society website (opens in a new tab).

Medication

Please bring with you all of your medications and its packaging (including inhalers, injections, creams, eye drops, patches, insulin and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital, such as x-rays or test results.

Please tell the ward staff about all of the medicines you use. Take your medications as normal on the day of the procedure unless you have been specifically told not to take a drug or drugs before or on the day by a member of your medical team. Do not take any medications used to treat diabetes.

Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart