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Peripheral Artery Surgery:


Peripheral artery disease is one that affects the arteries distal to the aorta. Among the most common are those of the lower and upper limbs. Carotid vessel involvement is treated independently in another section.


What are the most common diseases of the peripheral arteries?


The occlusion of a peripheral vessel causes muscle pain in the area supplied by that artery or what we call Intermittent Claudication. In the lower limbs it is known for the "window disease" due to the need of the patient to stand every few meters due to the pain in the legs. The obstruction is often the result of a chronic accumulation of hard fatty material (atherosclerosis or hardening of the arteries) in the inner lining of the arterial wall of the legs, due to factors such as diabetes, high blood pressure, excess cholesterol in the blood , tobacco and genetic factors. This ultimately causes a narrowing and blockage of the blood flow that carries oxygen and nutrients to the limb. The femoral and popliteal arteries are the main arterial blood supply to the lower extremities and are a common site where atherosclerosis develops.


The aneurysm of a peripheral vessel can cause rupture of the same, with the corresponding bleeding that can endanger the life of the patient. It originates due to genetic factors, atherosclerosis, or sustained high blood pressure.

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What is the intervention and when is it indicated?


In the case of arterial obstruction or stenosis, the operation is indicated when the disease causes a great limitation to daily activities, in the case of ulcers that do not heal or when there is a risk of loss of a limb. In the lower limbs, the intervention is indicated when the patient cannot walk on the level and at his pace more than 150 meters approximately. Sometimes the occlusion of the vessel is acute, due to a thrombus that either forms in situ or migrates from another place in the body (heart, for example). In these cases, urgent surgery is required in the shortest possible time.

  • Peripheral vascular bypass or bypass consists of connecting a graft from the proximal area of ​​the vessel disease to the distal area. With this we are able to "annul" the diseased area and make the blood reach the muscle to be irrigated through the graft. Sometimes we can make a graft from the contralateral side (femoral-femoral bypass or carotid-carotid bypass) or from distant arteries (maxillary-bifemoral bypass).

  • On other occasions, cleaning the stenosed area will suffice, removing the atheroma plaque that causes the stenosis. This is what is called an endarterectomy.

  • In cases of acute embolism, an embolectomy may be required, which is the introduction of a catheter with a balloon at the tip (Fogarty catheter) that cleans the artery by removing the thrombus. We usually perform it with local anesthesia, minimizing the time from arrival to the emergency room until the intervention.


In the case of peripheral aneurysms, intervention is indicated when the size of the aneurysm exceeds twice the usual size of that artery.


Who is in the operating room during the intervention?


During a peripheral vascular bypass procedure, a highly trained group works as a team. The following is a list of people who are in the operating room during a peripheral vascular bypass procedure.

  • The cardiovascular surgeon, who leads the surgical team and performs the intervention.

  • The assistant cardiovascular surgeons.

  • The cardiovascular anesthesiologist, who administers the medications that make the patient sleep during the intervention (anesthesia). It ensures that the patient receives the correct amount of drug during surgery and is in charge of controlling the monitors that monitor the patient's condition during the operation.

  • Cardiovascular nurses, who have received specific training to assist during an arterial intervention.


Before the intervention


Except in urgent cases, the intervention will be carried out on a date suitable for you and with the availability of an operating room by the surgeon. You must inform him of your recent state of health including if you have had a cold or fever. Remember to bring the medications you are taking or have taken in recent days to the Hospital. You will probably enter the day before or the morning of the intervention.


You will bathe and wash the area with an antiseptic. The area near the surgical field will be shaved. With this we avoid future infections. You will remain fasting for 6 hours before the intervention, in order not to suffer anesthetic complications. For this same reason, it is advisable that in case of smoking, do not do so for at least two weeks prior to the intervention.


After admission, an electrocardiogram, a blood test and a chest X-ray will be performed (if not already done).

As part of your pre-anesthetic medication, you will likely be given a sedative to help you relax before going to the operating room. Once in the operating room, you will be given a route through which to administer anesthetic drugs. You probably do not remember this after the intervention.


During the intervention:


The anesthesia will depend on the area to be treated. In the case of the lower limbs, it is usually with spinal anesthesia (similar to pregnant women). Your anesthesiologist will discuss the different anesthetic options with you in advance.


After anesthesia, the surgical field will be prepared.


The surgeon will make a cut (incision) in the site to be treated. In the case of a bypass, you will place a tube (shunt) in the artery, above and below the blockage. Bypassing allows blood to flow through the graft, supplying the distal muscles. The graft can be a vein from the patient himself (usually from the saphenous vein of the leg or thigh) or a dacron or PolyTetraFluoroEthylene prosthesis). In the case of Endarterectomy, it will clean the artery by removing any remaining atheroma and calcium plaque, closing the artery directly or through a vein or artificial patch (dacron / PTFE / pericardium).




If the anesthesia was general, you will wake up in the operating room. Both in this case and in the case of spinal anesthesia, you will go to a recovery area until you are ready to go to the ward, which can occur in 1 to 3 hours. On certain occasions we use local anesthesia with light sedation, so in those cases it would go directly to the ward.


On the floor, he will stay long enough to be able to fend for himself. In the case of shunts in the lower limbs, you must go 24 hours without walking. Hematomas may appear in the operated area, which will be reabsorbed within 1 week. If you notice pain, pain relievers will be given.

Life after peripheral vessel intervention:


Try not to do physically demanding activities for about a week. It could take as long as two weeks to fully recover.


After surgery on peripheral vessels, you should limit your consumption of fat and cholesterol. Your doctor may recommend a physical exercise program. Other lifestyle changes may also be necessary, such as quitting smoking, limiting alcoholic beverages, and controlling blood pressure and cholesterol levels.

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