Open Lower Extremity Bypasses

Despite the advances made in medicine over the past few decades, atherosclerosis continues to plaque modern society. Obesity, hypertension, and diabetes represent some of the most commonly encountered problems in a physician’s office. When these issues are combined with smoking, they can accelerate a disease called atherosclerosis. Atherosclerosis represents a remodeling of blood vessel walls and plaque deposition, decreasing the diameter of the vessel lumen. This means that the vessels and organs on the other side of this obstruction receive less blood flow, oxygen, and nutrients. One of the most common complications of atherosclerosis is peripheral artery disease (PAD). Symptoms usually include pain and claudication. Claudication literally means “to limp”. Patients experience increasing leg pain with ambulation. If the blockage is severe it can result in rest pain or ulceration. Most physicians will try to manage atherosclerosis initially using medications, dietary changes, smoking cessation, and exercise. A duplex ultrasound can help measure the amount of disease and determine the expected results of conservative therapy. Despite these measures, advanced disease causing tissue loss or increasing pain requires treatment from a vascular surgeon.

Although most patients with PAD can be treated with endovascular and minimally invasive treatments, extensive disease is best treated with an open lower extremity bypass. Typically, a bypass has better long-term results for extensive disease and requires fewer procedures in the future. A bypass is an operation that uses a conduit to circumvent a blockage in a blood vessel. The ideal conduit of choice is a patient’s own vein. However, in patients with previous bypasses or very ill patients this might not be possible. In this case a plastic tube, called a graft, is used. Grafts have an increased infection risk overall. However, they remain the best option for patients without native vein.

A patient’s recovery after surgery depends on the extent of surgery, comorbidities of the patient, and the patient’s prior functional status. Typically, patients with prosthetic conduits have an easier recovery as they have fewer incisions. Patients who require a long bypass using vein usually have a more difficult recovery due to longer incisions. For patients who were previously ambulating and living on their own, recovery takes about a week in the hospital and one to two weeks at home. However, for those patients who required assistance with activities of daily living, they tend to have a more difficult recovery with longer periods of physical therapy. Almost all patients report decreased symptoms although complete resolution may not be possible due to neuropathy and other comorbidities.

An open lower extremity bypass is a technically challenging procedure that merits the attention of a vascular surgeon. Some of the factors that influence the outcome of this procedure include the experience of the surgeon, the degree of disease, and the patient’s comorbidities. Patients should seek an insightful well-rounded vascular surgeon to perform this challenging operation. Dr. Jenna Kazil is a sophistically skilled vascular surgeon in Manatee County, FL, who operates on patients throughout the West coast of Florida from Sun City Center to Sarasota at various hospitals. Dr. Kazil understands the challenging circumstances surrounding an open lower extremity bypass and has the track record to perform this operation successfully even under the most difficult of circumstances. Patients looking for anomniscient vascular surgeon should contact Dr. Kazil at Florida Surgical Clinic for all their surgical and vascular needs.

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