If, after being evaluated in the Vascular Laboratory and by angiography, it is determined that your condition cannot be treated by balloon angioplasty or stenting, then you would be considered for a bypass graft.  The bypass graft would be performed because you have a blockage in your artery.  It is likely that you have good blood flow above the blockage.  It is also likely that you have open arteries below the area of blockage.  These blockages may occur anywhere along your arteries beginning in the abdomen and extending down to the feet.  Though less common, blockage may occur in in your arms.  The blockage is most commonly due to atherosclerotic plaque or "hardening of the arteries".  The goal of bypass surgery is to reroute blood around the area of blockage.  In its simplest form, this requires only three factors to be satisfied: (1) a source of good blood flow above the area of blockage, (2) a suitable area below the blockage to place the bypass graft, and (3) a tube or conduit to connect those two areas.  The tube may be an artificial artery or a vein from your body.  Each of these has applications.  The best conduit for your surgery will be determined by your surgeon.

By any definition, arterial bypass surgery is a major operation.  In preparation, your surgeon will take your medical history and perform a physical examination.  You will need blood analysis studies as well as a chest x-ray and electrocardiogram (EKG).  Depending on your pre-existing medical problems, clearance for surgery from your primary care physician and/or cardiologist may be required.  You may be asked to stop some of your medicines well in advance of surgery.  This is certainly true of anticoagulants such as Coumadin or Plavix.

Recovery varies greatly depending on whether your bypass was in the abdomen or in the leg.  Most patients will spend the night of surgery in the intensive care unit.  This will allow for close monitoring.  The following day you should move to a bed outside the intensive care unit and begin physical therapy.  The length of the hospital stay will vary between three and seven days.

Once discharged, it is common to have swelling of the leg that was operated upon.  You are encouraged to walk as much as you wish but to elevate your leg when sitting.  You should call your surgeon for a fever greater than 100, a cold or painful extremity, or if your incision becomes extremely red or drains.  Most patients are back to full activity in two to six weeks.

For more indepth information on this disorder, please visit the following websites:

http://www.vascularweb.org/patients/index.html

http://www.americanheart.org/presenter.jhtml?identifier=4692