The aorta is a large artery that carries oxygen-rich blood from the heart to the various parts of the body. It divides into 2 iliac arteries at the region of the navel. These extend below the groin region to form the femoral arteries. Pure blood flows through the aorta, iliac arteries and femoral arteries to supply oxygen to the lower parts of the body. In some cases, plaque or sticky substances such as cholesterol and calcium can build up on the inner wall of these arteries (atherosclerosis). Plaque deposition obstructs the flow of blood and decreases the oxygen supply to the tissues. This leads to a condition called peripheral artery disease (PAD). The condition can be treated surgically by a procedure called aortobifemoral bypass to restore the blood flow to your legs.
Aortobifemoral bypass is performed for atherosclerosis of the abdominal aorta or iliac arteries, and is indicated in cases of severe pain while walking (intermittent claudication), infected sores or ulcers on the extremities, gangrene, nerve damage, and need for amputation. Aortobifemoral bypass is recommended if you have multiple regions of blockage or a continuous, long obstruction in these arteries.
Before the surgery, your doctor will conduct a physical examination, and order a blood test and imaging tests to determine the location and severity of the PAD. You may be advised to undergo angiography (contrast dye is injected through a thin tube and X-rays are taken) to identify blocks in your arteries.
Aortobifemoral bypass is performed under general anesthesia. Sometimes epidural anesthesia is also provided. During the surgery, your surgeon makes an incision in your abdomen and smaller incisions in both groins. The affected blood vessels are exposed and the blood flow is temporarily stopped by placing clamps. The graft, an artificial tube or blood vessel taken from another part of your body is formed into a “Y”. The single end of the graft is sutured to the main branch of the aorta, before the plaque deposition and the two split ends of the “Y” are sutured to the femoral arteries, beyond the block. The clamps are removed and the incision closed with sutures. The blood can now flow freely through the bypass, around the blocked region. The entire procedure might take 3-4 hours to complete.
Common post-operative guidelines following aortobifemoral bypass include the following:
Like all surgeries, aortobifemoral bypass procedure may be associated with certain risks such as failure of grafts, infection, stroke, heart attack and sexual dysfunction as a result of pelvic nerve damage.
Aortobifemoral bypass is considered a successful procedure to keep the artery open and alleviate symptoms more than 80% of the time, and can last for nearly 10 years.