BYPASS AXILLO FEMORAL
- 1 Author's note
- 2 Click here for the PDF version of the leaflet
- 3 Your Operation - Some Information
- 4 What happens before the operation?
- 5 What happens after the operation?
- 6 After you leave hospital
- 7 General advice
- 8 Any Questions?
- 9 Any complaints?
- 10 Have you any comments?
- 11 Anything else?
This information describes what a patient may expect when having the described operation.
The information is specific to the author's practice.
Other surgeons will doubtless differ in their preferences.
The script can be down loaded and edited to suit other surgeons.
You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html
Your Operation - Some Information
These notes give a guide to your stay in hospital. They also give an idea of what it will be like afterwards. They do not cover everything. If you want to know more, please ask.
What is the problem?
The main artery that carries blood from your heart down to your legs is blocked near your navel. The legs are starved of blood. This causes pain in the legs, the risk of serious infection and even loss of the limbs.
The arteries below the blockage are in much better shape. They could take more blood flow. You would then get rid of the pain in your legs, and infection would heal up.
In your case we can channel a supply of blood from an artery just below your collar bone to your leg arteries in the groins. This is done by threading a new plastic artery under the skin from the collar-bone artery to the groin arteries.
Sometimes a new artery is put down each side. Sometimes a Y shaped artery is used to take blood from one collar-bone artery to both groin arteries. The exact plan for you will be explained. The arm and head are not starved of blood by these operations. You can feel the new artery beating but this is not troublesome.
What does the operation consist of?
One cut is made into the skin below the collar-bone and a cut is made in each groin to find the arteries. Tunnels are made under the skin to make a path for the new artery.
Sometimes an extra skin cut is needed over the bottom of your ribs where the new artery runs. The arteries are joined up and the cuts are stitched up. You should notice warm feet and loss of pain within 24 hours.
Are there any alternatives?
If you leave things as they are, your leg will get worse. You may get life threatening infection.
There are much bigger operations to unblock or bypass the arteries. They may be too much for you to stand at present.
Unblocking the arteries using lasers or x-ray controlled balloons will not work in your case.
Antibiotics and drugs to make the arteries open up will not be of use to you by themselves.
Overall I am sure the planned operation is the right one for you.
What happens before the operation?
Welcome to the ward
You will be welcomed to the ward by the nurses or the receptionist. You will have your details checked. You will be shown to your bed and will be asked to change into your nightwear. You will have some basic tests done, such as pulse, temperature, blood pressure and urine examination.
You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings.
Visits by the surgical team
You will be seen by the House Surgeon, who will interview and examine you. He, or she, will arrange some special tests such as x-rays and blood samples. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses, They are never too busy to do this.
You will have the operation site marked on you with a skin pencil.
You will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.
Visits by the anaesthetic team
One or more anaesthetists who will be giving your anaesthetic will interview and examine you. They will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had plus any anaesthetic problems in the family.
Visit by the physiotherapist
The physiotherapist will show you how to keep your chest clear after the operation and how to keep moving about. You should not smoke.
You will have your usual diet until 6 to 12 hours before the operation. Then you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during your operation.
You will be shaved from neck to thighs to prevent hairs affecting the wound.
The periods do not affect the operation.
Timing of the operation
The timing of your operation is usually arranged the day before. The nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.
You may be given a sedative injection or tablets about 1 hour before the operation.
Transfer to theatre
You will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. You will be wearing a cotton gown. Wedding rings will be fastened with tape. Removable dentures will be left on the ward. There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin. If you have a general anaesthesia you will go to sleep.
Sometimes it is safer for you to avoid a general anaesthetic. Then some type of injection will be given into your back to numb the places of the operations. The anaesthetist will talk to you about this.
The operation is then performed.
What happens after the operation?
Coming round after the anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. If you have only had an injection in your back you may still not remember much because of sedatives.
You will have a drip tube in an arm vein connected to a plastic bag on a stand containing a salt solution or blood.
You will have dressings on your wounds and possibly fine plastic drainage tubes in the nearby skin connected to plastic containers.
You may be given oxygen from a face mask for a few hours if you have had chest problems in the past.
You will have special thermometer pads strapped to your toes to check that the operation is working properly.
Warning after a General Anaesthetic
The drugs we give for a general anaesthetic will make you clumsy, slow and forgetful for about 24 hours. This happens even if you feel quite alright.
For 24 hours after your general anaesthetic:
Do not make any important decisions.
Will it hurt?
The wounds are painful and you will be given injections and later tablets to control this. Ask for more if the pain is still unpleasant.
You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.
The second day after operation you should be able to spend an hour or two out of bed.
By the end of four days you should have little pain.
Drinking and eating
You should be able to drink water the same day as your operation and move to a normal diet in a day or two.
Your bowels should open after 24 hours or so.
If you have not opened your bowels after 2 days and you feel uncomfortable, ask the nurses for a laxative.
It is important that you pass urine and empty your bladder within 6 to 12 hours of the operation. If you find using the bedpan or a bottle difficult, the nurses will help you to a commode or a toilet.
If you still cannot pass urine, let the nurses know. We will take steps to correct the problem.
You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.
The physiotherapist will check that you are clearing your lungs of phlegm by coughing. You should help your circulation by continuous movement of body and limbs.
The wound and stitches
Each wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be changed and the wounds will be sprayed with a cellulose varnish similar to nail varnish. You can take the dressings off after 48 hours. There is no need for dressings after this unless the wounds are painful when rubbed by clothing.
There are no stitches in the skin. The wounds are held together underneath the skin and do not need further attention.
Any plastic drainage tube is taken out after 2 days or so.
There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. The cellulose varnish will peel off and can be assisted with nail varnish remover.
Occasionally minor matchhead sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so.
You will have tiny injections into the tummy skin twice a day to keep the circulation going.
You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want.
What about informing my relatives and contacts?
With your permission, the nurses and doctors will keep your relatives and contacts up to date with your progress.
You should plan to leave hospital 7 days after the operation, provided the legs are healthy.
The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged.
You will be given an appointment to visit the Out Patient Department for a check up about one month after you leave hospital.
Please ask the nurses for sick notes, certificates etc.
After you leave hospital
You are likely to feel very tired and need rests 2 or 3 times a day for a month or more. You will gradually improve so that by the time 2 months has passed you will be able to return completely to your usual level of activity.
You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks.
What about sex?
You can restart sexual relations within 2 or 3 weeks when the wound is comfortable enough.
You should be able to return to a light job after about 6 weeks and any heavy job within 12 weeks.
Complications are unusual but are rapidly recognised and dealt with by the nursing and surgical staff.
If you think that all is not well, please ask the nurses or doctors.
Sometimes there is bleeding under the skin which cause more severe bruising or swelling.
Sometimes fluid builds up under the groin wound. This settles down.
Sometimes the blood in the new artery clots. This usually means a second operation to clear the blockage. You can help prevent this by not lying or pressing on the new artery. You should avoid tight clothing or corsets. You must not smoke.
Sometimes the arteries down the leg cannot take the extra blood flow. The steps to deal with this will be discussed with you.
Wound infection is sometimes seen. This usually settles down with antibiotics.
Aches and twinges may be felt in the wound for up to 6 months.
Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.
The operation may sound unusual, but it gives good results so long as the blood does not clot.
You should never smoke after the operation.
If you have any problems or queries, please ask the nurses or doctors.
If you have any questions, jot them down here and ask the doctors or nurses for answers.
If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to your surgeon
Have you any comments?
We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name.
Date of stay in hospital:
Out patients department:
Your admission arrangements:
Your welcome on the ward:
General ward atmosphere:
Did you know who was who?:
Food and drink:
Timing of operation:
Preparations for your operation:
Going into the theatre:
In the operating theatre:
In the recovery room:
Coming back from theatre:
Intensive Care ward:
Recovery on the ward:
Tablets, medicines, injections:
Out-patient follow up:
Continue comments overleaf if you wish.
Please send this questionnaire to your surgeon.