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Aorta-Iliac Bypass Graft Surgery

Last updated March 17, 2018

The Aorta-Iliac Bypass Graft Surgery is a procedure where the aorta is connected to the iliac artery with a prosthetic material (graft).


Background Information:

What are the other Names for the Procedure?

  • Aortoiliac Bypass Graft Surgery
  • Aortoiliac Bypass Surgery
  • Aortoiliac Reconstruction

What is Aorta-Iliac Bypass Graft Surgery surgical procedure?

The Aorta-Iliac Bypass Graft Surgery is a procedure where the aorta is connected to the iliac artery with a prosthetic material (graft). It is performed under general anesthesia. In some cases epidural anesthesia is also administered. Epidural anesthesia is used to numb the body below the chest.

What part of the Body does the Procedure involve?

The Aorta-Iliac Bypass Graft Surgery involves the aorta and iliac arteries.

Why is the Aorta-Iliac Bypass Graft Surgery surgical procedure Performed?

An Aorta-Iliac Bypass Graft Surgery is performed when the lower portion of the aorta or the upper portion of the iliac arteries are blocked. The surgery ensures a normal and correct amount of blood supply to the lower portion of the torso and lower extremities.

What are some Alternative Choices for the Procedure?

If the patient suffers from severe blockage in both the aorta and iliac arteries, the Aorta-Iliac Graft Bypass is the best method available to correct the defect. However, during the initial stages medications may prove helpful.

What are the Recent Advances in the Procedure?

The recent advances (though still in a study-trial stage) are related to the use of several different techniques to perform the graft bypass surgery.

What is the Cost of performing the Aorta-Iliac Bypass Graft Surgery surgical procedure?

The cost of Aorta-Iliac Bypass Graft Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Aorta-Iliac Bypass Graft Surgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.med.nyu.edu/content?ChunkIID=100981#expect

http://www.lifescript.com/health/a-z/treatments_a-z/procedures/a/aortoiliac_and_aortofemoral_bypass_graft_surgery.aspx

Prior to Aorta-Iliac Bypass Graft Surgery surgical procedure:

How is the Aorta-Iliac Bypass Graft Surgery surgical procedure Performed?

  • In an Aorta-Iliac Bypass Graft Surgery, a big incision is made in the abdomen; the aorta is then located and isolated, from among the abdominal organs
  • The aorta and the iliac arteries are clamped temporarily to stop the flow of blood
  • A prosthetic graft made of polytetrafluoroethylene (PTFE) or polyethylene terephthalate (PET or PETE) or Dacron graft is positioned below the clamp on the aorta and above the clamp on the iliac artery and sewn in place
  • Now the surgeon checks and ensures that there is a proper blood flow through the graft by removing the clamps
  • If the graft functions properly, then the abdominal organs are carefully placed back in position, the abdominal muscles closed, and the skin sutured or stapled

Where is the Procedure Performed?

The procedure is performed at a hospital.

Who Performs the Procedure?

The surgery is normally performed by a vascular surgeon or a trained general surgeon.

How long will the Procedure take?

Typically, an Aorta-Iliac Bypass Graft surgical procedure takes about 3-4 hours’ time.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines 

A physician will request your consent for the Aorta-Iliac Bypass Graft Surgery procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Aorta-Iliac Bypass Graft Surgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Aorta-Iliac Bypass Graft Surgery surgical procedure?

Depending on the patient’s medical history and overall health status the physician may request the following tests:

  • Routine blood tests
  • Urine analysis
  • Ankle Brachial Test: This test measures the blood pressure in both the arms and legs. If the pressures in the legs are noted to be lower than the required value, it signifies a possible blockage
  • Doppler Ultrasound: This test involves the use of sound to determine blockage in the arteries
  • Angiography, or a CT Scan, or an MRI Scan

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician/surgeon are as follows:

  • What is an Aorta-Iliac Bypass Graft surgery?
  • Why is this procedure necessary? How will this procedure help?
  • What does the procedure involve?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the possible complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • What will happen if the bypass graft surgery fails? Will the graft cause an internal reaction/allergy?
  • Will the graft require replacement after a few years?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Aorta-Iliac Bypass Graft Surgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

A general anesthesia is normally administered; but in some cases epidural anesthesia might be given. 

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally controlled; but if complications arise during the procedure, it could lead to a further loss of blood.

What are the possible Risks and Complications during the Aorta-Iliac Bypass Graft Surgery surgical procedure?

The possible risks and complications that may arise during the surgery are:

  • Excessive bleeding
  • Surgical wound infection
  • Graft infection
  • Accidental injury to the neighboring tissue or organ
  • Formation of blood clots, which may lead to obstructed blood flow in the grafts
  • Nerve damage

What Post-Operative Care is needed at the Healthcare Facility after the Aorta-Iliac Bypass Graft Surgery surgical procedure?

The following post-operative care is needed at the out-patient facility:

  • The patient is usually placed in an intensive care unit, for 1-2 days, for immediate post-operative care
  • To check proper functioning of the lungs, a spirometer may be used periodically
  • Nasogastric (NG) tube is retained after the surgery, till the patient’s intestines begin to function normally
  • Daily medications might be given to relieve pain, avoid blood clots, prevent infection, and aid in a speedier recovery

After the Aorta-Iliac Bypass Graft Surgery surgical procedure:

What are the possible Risks and Complications after the Aorta-Iliac Bypass Graft Surgery surgical procedure?

The possible risks and complications that may arise after an Aorta-Iliac Bypass Graft Surgery are:

  • Infection
  • Bleeding
  • Injury to the neighboring structures
  • Pain
  • Anesthetic complications
  • Blood clots, causing occlusion of blood flow to the lower extremities
  • Compartment syndrome: Increased pressure within the muscle compartments of the legs, necessitating immediate surgical intervention
  • Occlusion of the graft
  • Impotence
  • Incisional hernia
  • Kidney or liver problems

What is the Prognosis after the Surgery?

  • The Aorta-Iliac Bypass Graft Surgery has a high success rate. The mortality rate associated with the surgery is generally low
  • If the person has maintained a healthy lifestyle; post-surgery the patency rate (condition of being unblocked or open) is found to be very high even after 5 years

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Feeling of numbness in lower limbs, or they have become cold and/or discolored
  • Unbearable pain in and around the surgical wound
  • Swelling and redness around the surgical wound
  • Signs of infection
  • Nausea, vomiting, feeling of dizziness
  • Constipation
  • Muscular aches
  • Shortness of breath
  • Chest pain

What Post-Operative Care is needed at Home after the Aorta-Iliac Bypass Graft Surgery surgical procedure?

At home, the following post-operative care is recommended, after an Aorta-Iliac Bypass Graft Surgery procedure:

  • Complete the course of prescribed medications
  • Keep the area around the incision clean and dry
  • Avoid strenuous activity for 6 weeks (per physician’s advice)
  • Prevent the occurrence of any constipation; take stool softeners if necessary
  • Avoid smoking or taking any nicotine-based product
  • Keep check on the blood sugar count; it must be maintained within the normal range

How long does it normally take to fully recover, from the Procedure?

Generally, it takes about 6 weeks to recover completely from an Aorta-Iliac Bypass Graft Surgery, if no complications arise.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Aorta-Iliac Bypass Graft Surgery does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Aorta-Iliac Bypass Graft Surgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • A vascular or a general surgeon
  • An anesthesiologist 

The patient is advised to inquire and confirm the type of billing, before the Aorta-Iliac Bypass Graft Surgery procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 23, 2013
Last updated: March 17, 2018