Vascular diseases are found in both women and men. More often pathologies affect middle-aged and elderly people. Less commonly, vascular diseases are observed in young people. In some cases, these pathologies are congenital. Typical localization of the lesion of the vascular system are the coronary, cerebral arteries, veins of the rectum and lower extremities. However, with systemic vasculitis, the process can be spread throughout the body. One of the frequent reasons for seeking a surgeon is varicose veins. This pathology is more common in women. The characteristic symptoms are: tortuous veins, their expansion, protrusion. Atherosclerosis is considered another vascular disease. It leads to blockage of arteries and impaired blood flow. In advanced cases, in both pathologies, the vessels of the lower limbs are bypassed. This is a surgical operation, due to which the blood flow can be fully restored.
What is the purpose of the bypass vessels of the legs?
A forced measure for diseases of the veins and arteries is the bypass of the vessels of the lower extremities. Treatment at the initial stages is carried out conservatively. Patients suffering from atherosclerotic lesions are prescribed lipid-lowering drugs (drugs "Atorvastatin", "Fenofibrate"), diet. In case of varicose veins, it is recommended to wear special elastic underwear, sclerotherapy. Shunting of vessels of the lower extremities is carried out with severe blockage of the lumen of an artery or vein, high risk of thrombus formation and the development of gangrene. This procedure is a surgical procedure, the surgeon must perform it. Shunting is the replacement of an area of a vessel with an implant. As a result, the blood supply is restored, and the risk of blood clots is significantly reduced. The shunt can be made of artificial materials or the patient’s own tissue. Often, adjacent vessels of the lower extremities are used as an implant. The choice of material depends on the diameter of the damaged artery or vein, as well as on the characteristics of the pathology.
Indications for shunting of vessels of the lower extremities
The operation for shunting of vessels of the lower extremities is carried out in a specialized or surgical department of the hospital. It belongs to difficult procedures, therefore it should be carried out only under strict indications. It is worth resorting to vessel bypass surgery if more than 50% of the artery or vein diameter has been occluded. Before making a decision about the operation, doctors prescribe conservative treatment. Surgical intervention is performed in the absence of the effect of therapy. The following indications for shunting of vessels of the lower extremities are distinguished:
- Atherosclerosis of the arteries.
- Pronounced pathology of the venous system. More often, with varicose veins and threats of thrombophlebitis, stenting or angioplasty is performed. In case of contraindications to such methods of treatment, vessel bypass surgery is performed.
- Endarteritis. In this pathology, the inflammatory response is combined with progressive obliteration of small vessels. Gradually, the arteries become completely blocked, leading to gangrene of the foot. This disease is more common among the male population.
- Aneurysm of lower limb arteries. Pathology is dangerous at high risk of bleeding, which is extremely difficult to stop.
In some cases, bypass vessels of the lower extremities are performed during gangrene of the toes or of the foot. The prognosis for this surgical intervention is not always favorable and depends on the area of necrosis and the individual characteristics of the organism. In some cases, the operation leads to the healing of gangrene or reduction of the size of the affected lesion.
In what situations is shunting contraindicated?
Despite the effectiveness of vessel shunting, it is worth remembering that such an operation is very serious. Therefore, it is performed only in cases where other treatments do not help. There are a number of contraindications for shunting. Among them:
- Hypertension, not controlled by antihypertensive drugs. In this case, vascular surgery may lead to cardiogenic shock, myocardial infarction, or stroke.
- Decompensated heart failure, accompanied by edema syndrome and constant shortness of breath.
- Unstable angina.
- Acute heart failure and myocardial infarction.
- Aneurysm of aorta, cerebral vessels.
- Paroxysmal arrhythmias.
Shunting of vessels of the lower extremities should not be carried out with infectious diseases, skin lesions, decompensation of diabetes. In these cases, the operation is performed after stabilization of the patient.
Most often, artery bypass surgery is performed. This is due to the fact that such pathologies are more common. In addition, with the defeat of the veins other methods of treatment are recommended. Among them are balloon angioplasty and stenting. As shunts to restore arterial blood flow using the saphenous vein of the thigh. With a large lesion area or the unsatisfactory condition of the vessels, synthetic implants are used. There are several methods of operation. Among them:
- Aorto-bifemoral shunting. Surgical intervention is performed at the level of the inguinal region. The essence of the operation is to create a bypass anastomosis between the abdominal part of the aorta and the femoral arteries.
- Femoral popliteal bypass. An anastomosis is formed between two large arteries of the lower limb. The shunt originates at the base of the thigh and is applied to the region of the knee joint (below or above the articulation).
- Cross shunting. The anastomosis passes between two femoral arteries (from the right leg to the left lower limb, or vice versa).
- Femorotibial shunting. A vascular graft connects the femoral and tibial artery.
Preparing the patient for vascular bypass surgery
Preparation for shunting includes a number of diagnostic procedures, as well as the use of drugs. Before the operation, it is necessary to undergo a laboratory examination: OAK, OAM, biochemical blood test, coagulogram. Doppler sonography of the lower extremities, ECG, EchoX is also performed. To avoid blood clots during surgery, drugs are prescribed to thin the blood a week before it. These include the medicines Aspirin Cardio, Magnicor. Antibiotics and anti-inflammatory drugs are also prescribed. In the evening, on the eve of the operation, you must stop taking water and food.
Technique of shunting vessels of the lower extremities
Shunting of vessels of the lower extremities is a complex operation that requires high professionalism of the surgeon. The procedure is performed under general anesthesia. The incision of the skin and underlying tissues is carried out in 2 locations - above and below the affected area of the artery. Clamps are placed on the vessel to prevent bleeding. After assessing the affected area, an incision is made on the vessel and the shunt is fixed on one side. Next, the vascular flap is fixed between the muscles and tendons. Thus, the shunt is gradually brought to the place of the second incision (above the lesion) and its end is fixed. After that, the surgeon assesses the state of blood flow. With a successful operation, the artery begins to throb. In some cases, instrumental examination methods are performed. The final stage of surgical intervention is the closure of deep tissues and skin.
How is the postoperative period?
Inpatient monitoring of the patient undergoing surgery is very important. Especially if this manipulation is shunting of the vessels of the lower extremities. The postoperative period for successful treatment is about 2 weeks. On the 7-10 day, the surgeon removes the stitches. While the patient is in the hospital, it is necessary to perform diagnostic procedures to evaluate the effectiveness of the treatment. In addition, the physician must ensure that there are no postoperative complications. In the first days after the operation, it is recommended to get up on your feet. When sitting and lying down, lower limbs should be fixed in a raised position.
Recommendations in the recovery period
After shunting of the vessels of the lower extremities, it is necessary to monitor the state of the blood flow. To this end, the patient should be examined periodically (ultrasound and Doppler). Also recommended:
- Refuse to smoke.
- Take antiplatelet drugs to prevent thrombosis.
- Watch for body weight. With an increase in BMI, a lipid-lowering diet and drug therapy are prescribed.
- Do daily walks on foot.
- Wear special stockings (socks) and shoes.
Shunting of vessels of the lower extremities: patient reviews
Reviews of patients who underwent surgery, mostly positive. Patients report a decrease in pain, numbness in the legs. However, in some cases, people complain of recurring symptoms after a while. This is due to the lesion of the neighboring arteries and veins. It is worth remembering that bypass surgery is not a treatment for atherosclerosis, and the cause of vascular lesions does not disappear after surgery. Therefore, to avoid thrombosis and the development of gangrene, it is important to observe preventive measures.
Shunting of vessels of the lower extremities: complications of the operation
Complications of the operation include the formation of a thrombus in the shunt, the development of acute heart failure, pulmonary embolism. In the recovery period, there may be suppuration of the wound in the area of sutures and bleeding from it. Despite the fact that the operation is considered difficult and lengthy (up to 3 hours), complications are rare. The frequency of their development is about 2%.