Patient Information - Femoro-popliteal / distal bypass Grafts
at QMC
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1. Why do I need the operation?
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| Because you have a blockage or narrowing of the
arteries supplying your legs, the circulation of blood 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 the leg so that the
blood supply is improved. |
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2. Before your operation.
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| You will usually be admitted into the QMC the day before your operation.
Before this, you will be asked to
attend a pre-admission clinic about a week earlier to meet some
of the staff who will look after you and for them to explain
what will happen to you. At this meeting, Mr Braithwaite or one
of his team will review the tests that you have had. These may include
an angiogram or duplex scan,
special scans of your heart and tests on how your lungs and
kidneys are working. If you have not done so already, you will be
asked to sign a consent
form. |
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3. Coming into hospital.
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| 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 the Surgeon 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. When in hospital, Mr Braithwaite may arrange a duplex
scan of your leg to see whether one of the veins
in your leg can be used for the bypass. |
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4. The operation.
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| 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.
You will either be put to sleep (a general anaesthetic) or
you will have a tube inserted into your back through which pain
killers can be given to numb the lower half of your body
(epidural). Sometimes you will have this as well as the
general anaesthetic to provide pain relief after your surgery.
Whilst you are asleep, tube may be inserted into your
bladder to drain your urine, and into a vein in your arm or neck
(or both) for blood pressure measurements and
administration of fluid following surgery. You will have a cut
in the groin and one somewhere lower down your leg depending on
which blood vessel is being bypassed. Often these will be
connected as a long cut all the way down the leg. The bypass
will be usually be performed by using your own leg vein
(don't worry-you can manage without it) but an artificial bypass
tube made of plastic may be used instead. The wounds are often
closed with a stitch under the skin that dissolves by
itself. For bypasses to the ankle, Mr Braithwaite sometimes
leaves part of the wound open to help a more important cut to
heal. This is called a skin relieving incision. If he uses this
cut, it will gradually heal. |
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5. After the operation.
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| After your operation you will be given fluids by a
drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses
and doctors will try and keep you free of pain by giving
pain killers by injection, via a tube in your back, or by a
machine that you are able to control yourself by pressing a
button (PCA). As the days pass and you improve the various tubes will
be removed and you will become gradually more mobile until you
are fit enough to go home. You will be visited by the
physiotherapist before and after your operation who will help
you with your breathing to prevent you developing a chest
infection and with your walking. |
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6. Going home.
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If dissolvable stitches have been used, these do
not need to be removed. If your stitches or clips are the
type that need removing, and this is not done whilst you are
still in hospital, the practice or district nurse will
remove them and check your wound. You will feel tired for many
weeks after the operation but this should gradually improve
as time goes by. Regular exercise such as a short walk combined
with rest is recommended for the first few weeks following
surgery followed by a gradual return to your normal
activity.
Driving: You will be safe to drive
when you are able to perform an emergency stop. This will
normally be at least 4 weeks after surgery, but if in doubt
check with your own doctor.
Bathing: Once your wound is dry you
may bathe or shower as normal.
Work: You should be able to return
to work within 1-3 months following your operation. If in doubt
please ask your doctor.
You will usually be sent home on a small dose of aspirin if you
were not already taking it. This is to make the blood less
sticky. If you are unable to tolerate aspirin an alternative
drug may be prescribed. |
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7. Complications.
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| Graft Failure:
The main complication with this sort of operation
is blood clotting within the graft causing it to block, and
if this occurs it will usually be necessary to perform another
operation to clear the graft.
Amputation:
If your leg is in danger
because of its poor blood supply prior to surgery, there is a
risk of you ending up with an amputation if the graft
blocks.
Infection:
Slight discomfort and twinges of pain in your wound is
normal for several weeks following surgery, but wounds
sometimes become infected and these can usually be successfully
be treated with antibiotics.
Seroma:
The wound in your groin
can fill with a fluid called lymph that may discharge between
the stitches but this usually settles down with time.
Numbness: You may
have patches of numbness around the wound or lower down the leg
which is due to cutting small nerves to the skin. This can
be permanent but usually gets better within a few months. It
is also common for the foot to swell due to the improved blood
supply. Elevation of the leg when sitting helps the fluid
to disperse.
Graft Infection: This is
rare but if a plastic graft becomes infected, it may need to be
removed.
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8. What can I do to help myself?
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| If you were previously a smoker you must make a
sincere and determined effort to stop completely. Continued
smoking will cause further damage to your arteries and your
graft is more likely to stop working. General health measures
such as reducing weight, a low fat diet and regular exercise are also
important. If you develop sudden pain or numbness in the leg
which does not get better within a few hours then contact
the hospital immediately. |
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