تعريف

In this surgery, the patient’s vein or an artificial tube is used to create a bypass around a blocked main leg artery. The blocked arteries in the legs are usually caused by a buildup of plaque. When this buildup occurs, it is called peripheral arterial disease (PAD).

Femoropopliteal Bypass Surgery 1

أسباب هذا الإجراء

  • To restore proper blood supply to your lower leg
  • To relieve leg pain caused by a blocked artery
  • To prevent the need for amputation

المضاعفات المحتملة

If you are planning to have femoropopliteal bypass surgery, your doctor will review a list of possible complications, which may include:

  • نزيف
  • Blood clots (eg, clots that causes blockage of bypass graft)
  • العدوى
  • Adverse reaction to the anesthesia
  • Organ damage
  • Need for limb amputation
  • Heart attack or death

تأكد من مناقشة هذه المخاطر مع طبيبك قبل الإجراء.

ما يمكن توقعه

قبل الإجراء

طبيبك سوف المرجح أن تفعل ما يلي:

  • تحاليل الدم
  • مخطط كهربية القلب (ECG ، EKG) - اختبار يسجل نشاط القلب عن طريق قياس التيارات الكهربائية عبر عضلة القلب
  • Chest x-ray —a test that uses radiation to take pictures of structures inside the body
  • Ultrasound—a test that uses soundwaves to make an image

قبل الجراحة:

  • التحدث مع طبيبك عن الأدوية الخاصة بك. قد يطلب منك التوقف عن تناول بعض الأدوية تصل إلى أسبوع واحد قبل العملية مثل:
    • الأدوية المضادة للالتهابات (مثل الأسبرين)
    • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
  • If advised by your doctor, take antibiotics to prevent an infection.
  • رتبي للحصول على المساعدة في المنزل بعد الجراحة.
  • The night before the surgery, have a light dinner. Do not eat or drink anything after midnight.

التخدير

قد تحصل على:

  • General anesthesia (almost always used)—blocks pain and keeps you asleep through the surgery
  • Spinal anesthesia —the area from the chest down to the legs is numbed; given as an injection in the back

وصف الإجراء

The doctor will make a cut in the skin on the leg. Through this cut, the doctor will take out a vein that will be used to make the bypass. If the vein cannot be used, then an artificial vein is used.

Next, an incision will be made in the groin to expose the femoral artery. This is the artery in the thigh. The doctor will make another incision at the back of the knee to expose another artery. This is called the popliteal artery.

The doctor will use clamps to block the flow of blood through these two arteries. One end of the new bypass vein will be stitched into the femoral artery, and the other end will be stitched into the popliteal artery. Once attached, blood will be passed through the graft to check for leaks. If leaks are found, the doctor will repair them. The clamps will then be removed. This will allow blood to flow through the graft to the lower leg. The doctor will use stitches to close the incisions.

In some cases, a vein in the thigh will be used as a graft while left in place. This is called in situ. In this procedure, the valves inside the vein will be removed with a small scope and a small cutting tool. The vein will then be attached to the arteries to form a graft.

مباشرة بعد الإجراء

  • For the first 24-48 hours, fluids and pain medicines may be given by IV.
  • You may need to wear an oxygen mask for the first 10-12 hours.
  • An epidural in your back (to numb the site and relieve pain) may be left in place for the first 3-5 days. Once this is removed, your doctor will give you pain medicine.

كم من الوقت سيستغرق ؟

1-3 ساعات

كم هو مؤلم ؟

As you heal and the swelling in your leg subsides, you may have pain for weeks or even months. Ask your doctor about medicine to help with the pain. Keep in mind that it is normal for your leg to remain swollen for 2-3 months.

متوسط ​​الإقامة في المستشفى

7-10 days

رعاية ما بعد العملية

في المستشفى

While you are recovering at the hospital, you may be instructed to:

  • For the first 1-2 days, use cold packs to decrease pain and swelling. A nurse will apply a cold pack to the area for 15-20 minutes each time.
  • You may wear boots or special socks to help prevent blood clots
  • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
  • Your incision will be examined often for signs of infection.

في البيت

عند عودتك إلى المنزل، قم بما يلي للمساعدة في ضمان التعافي بسلاسة:

  • Do not drive for 4-6 weeks, or until you are pain free.
  • If advised by your doctor, walk every day. Walking will make your legs stronger. Slowly increase how far you walk.
  • Work with a physical therapist.
  • Slowly increase the activity you do each day.
  • When sitting, keep your legs elevated.
  • Place a pillow under your leg when sleeping.
  • اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
  • Keep the wound dry. Avoid using talc or powder.
  • Avoid fatty foods.
  • Do not smoke. Smoking can interfere with healing.
  • تأكد من اتباع تعليمات طبيبك.

استدعاء الطبيب

  • علامات الإصابة, بما في ذلك حمى وقشعريرة
  • Severe pain in the leg
  • تصبح ساقك باردة أو شاحبة أو زرقاء أو وخز أو خدر
  • احمرار أو تورم أو ألم متزايد أو نزيف شديد أو أي إفرازات من موقع الشق
  • Nausea, vomiting, or constipation
  • ألم لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك
  • السعال، ضيق التنفس، أو ألم في الصدر
  • Dizziness or weakness
  • ألم و/أو تورم في قدميك، أو ساقيك، أو ساقيك
  • ألم أو حرقة أو إلحاح أو كثرة التبول أو نزيف مستمر في البول
  • أعراض جديدة غير مبررة

في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.

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