Vascular Surgery: Overview

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Vascular surgery entails going around a blocked or narrowed artery in order to restore blood flow to an organ (e.g., the heart or brain) or an extremity (most commonly, a leg). To create an alternative path for blood flow, a surgeon uses a natural or synthetic graft to connect a healthy artery to the narrowed artery beyond the blocked point.

While there are different types of vascular bypass graft surgeries that can be done depending on the location of the blockage, they are generally all major surgeries that require an extensive recovery process.

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Coronary Artery Bypass Surgery: A Type of Vascular Bypass


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What Is Vascular Bypass Graft Surgery?

Vascular bypass graft surgery is an inpatient procedure performed by a cardiothoracic surgeon, neurosurgeon, or vascular surgeon in a hospital under general anesthesia. Bypass surgeries are typically scheduled in advance, although they may be performed emergently.

Common bypass surgeries and their associated sites include:

  • Coronary artery bypass surgery (heart)
  • Cerebral artery bypass surgery (brain)
  • Lower extremity bypass surgery (legs)
  • Renal artery bypass surgery (abdomen)
  • Aortoiliac or aortofemoral bypass surgery (abdomen)

For each bypass surgery, a graft must be chosen to create a new route around the blocked section of the artery. The graft may be taken from a vein or artery, or be synthetic (man-made).

Natural grafts, such as the saphenous vein (located in the leg) and the radial artery (located in the wrist) tend to last longer than synthetic ones (e.g., Dacron or polytetrafluoroethylene).

Various Surgical Techniques

Bypass surgery is traditionally performed as an open surgery. This means that a large incision is made to access the narrowed or blocked artery and its associated organ. That said, over the years, less invasive techniques have emerged for some types of bypass surgery.

For example, some surgeons perform a minimally invasive direct coronary artery bypass. This technique involves the surgeon making several small incisions in the chest to access their coronary arteries. These smaller cuts expose the diseased parts of the arteries that require grafts.

While this technique minimizes infection risk and prevents a large scar from developing, it cannot be used to treat more than two coronary arteries during the same operation.

With coronary artery bypass surgery, there is also a robotic-assisted technique in which very tiny (key hole-sized) incisions are made in the chest. A small video camera is inserted through one of the incisions to project visuals of the heart onto a screen. The surgeon then uses specialized remote-controlled surgical instruments to perform the bypass. 



Contraindications

Contraindications vary based on the type of bypass surgery being performed. Your surgeon's discretion will also affect whether a procedure is considered appropriate for you or not.

In the case of coronary artery bypass, for example, relative contraindications include:

  • Low risk of myocardial infarction (heart attack) or death with no symptoms
  • Advanced age (especially over age 85
  • Coronary arteries incompatible with grafting

Relative contraindications to undergoing peripheral vascular bypass graft surgery (bypassing an artery within the leg or abdomen) include:

  • Prior cardiac intervention (stenting, angioplasty, or coronary artery bypass)
  • Low ejection fraction, a measure of heart strength
  • Respiratory illnesses, like COPD

Be sure to review your health history, including any procedures you have had, with your surgical team.

Potential Risks

Vascular bypass graft surgery carries multiple potential risks, including:

  • A wound or vascular graft infection
  • Bleeding during or after the surgery
  • Blood clots
  • Pneumonia
  • Kidney failure
  • Heart attack or arrhythmias
  • Stroke
  • Graft failure
  • Seizures (with cerebral bypass surgery)
  • Nerve damage (with peripheral vascular bypass)
  • Death

Purpose of Vascular Bypass Graft Surgery

The goal of vascular bypass graft surgery is to bypass a blocked and narrowed artery and restore, or revascularize, blood flow. Arteries can become narrowed or blocked as a result of atherosclerosis (when fatty clumps called plaques buildup).

Arteries that may be bypassed include the following:

  • Coronary arteries: When plaques clog the arteries that supply the heart (called coronary artery disease), angina—and eventually, a heart attack—may occur.
  • Cerebral arteries: When arteries that supply the brain become blocked with plaque (called cerebrovascular disease), a stroke may occur.
  • Leg arteries: When arteries in the legs become clogged with plaque (called peripheral artery disease), pain in the back of the lower leg that worsens with exercise and improves with rest may develop. This is known as claudication.
  • Renal arteries: Kidney disease and refractory high blood pressure may develop from narrowing of the kidney arteries (called renal artery stenosis).
  • Aorta: Atherosclerosis of the aorta may result in an aortic occlusion.

For all of these conditions, treatment with medicine or through minimally invasive means is usually attempted before bypass surgery is considered.

For example, in the case of peripheral artery disease and coronary artery disease, lifestyle changes (e.g., smoking cessation) and medications (e.g., a statin) are initiated first. If these therapies are insufficient, angioplasty and stenting is usually the next option, followed by bypass surgery.

Keep in mind: When bypass surgery is being considered, several pre-operative tests will need to be run—weeks before the surgery, if possible—depending on the bypass site.

Examples of such tests include:

How to Prepare

Once a vascular bypass graft surgery is scheduled, your surgeon will give you specific instructions to follow.

These instructions may include:

  • Stop smoking as soon as possible.
  • Stop or continue certain medications prior to surgery.
  • Avoid eating or drinking anything after midnight on the eve of your surgery.
  • Shower the evening before and the morning of surgery using a special antibacterial soap.
  • Notify your work that you will be out for a few weeks, if applicable.
  • Prepare for recovery (e.g., pay your bills early, freeze meals, and arrange for someone to drive you to doctor's appointments).

What to Expect on the Day of Surgery

The operation time for a bypass surgery depends on the bypass site and the severity of the condition being treated (sometimes more than one bypass graft is done). That said, surgeries typically take one to six hours and require a two- to seven-night stay in the hospital.

When you arrive at the hospital, you will go to a pre-operative room where you will change into a hospital gown. A nurse will then record your vitals and place an IV in your arm or hand. This IV will be used to deliver fluids and medication both during and after the procedure. An arterial line (a thin catheter that goes in an artery in your wrist) may also be placed to monitor your blood pressure.

You will then wait in a holding area until the surgical team is ready for your procedure. When ready, you will be wheeled into the operating room on a gurney.

An anesthesiologist will give you medications to put you to sleep; a breathing (endotracheal) tube will then be inserted. A catheter to drain urine will be placed along with inflatable compression devices around your legs (to help prevent blood clots).

The flow of your procedure will depend on the type of bypass surgery you are having. That said, the following offers a general breakdown of what occurs:

  • Incision: After the skin is cleaned, the surgeon will make a large skin incision in the area where the arterial blockage is (for example, the middle of the chest to access the coronary arteries, the abdomen to access the aorta, or the groin to access a leg artery).
  • Access: Muscles, tissues, and even bone beneath the skin may need to be moved or cut to expose the blocked artery. For instance, with coronary artery bypass surgery, the sternum (breastbone) is cut in half and separated in order to access the coronary arteries. With cerebral bypass surgery, part of the skull is removed to expose the brain (called a craniotomy).
  • Harvesting: As the bypass site is being accessed by the surgeon, another surgeon or surgical assistant may remove (harvest) a section of a healthy blood vessel to serve as the graft. For example, with coronary artery bypass surgery, a graft may be harvested from the saphenous vein or the radial artery.
  • Grafting: Once the bypass site is exposed and the graft is harvested, the surgeon will sew the graft into a tiny opening below the diseased artery. The other end of the graft will be sewed to another part of a healthy artery. The surgeon will use a doppler ultrasound or special fluorescent dye to ensure adequate blood flow.
  • Closure: The surgeon will then close everything (bone/muscle/skin) back up. A sterile bandage will be applied over the large incision site.
  • Prep for recovery: The breathing tube may be taken out at this time or left in and removed once you are more stable in your recovery/hospital room. You will be wheeled into a post-operative care unit (PACU) where you will wake up from anesthesia.

Note, however, that other surgical steps may be performed depending on the procedure. For instance, with coronary artery bypass surgery, you may be placed on a heart-lung bypass machine, which allows the heart to stop beating while the graft is being sewn in.

Recovery

After waking up in the PACU, you will be moved to an intensive care room (e.g., cardiac ICU or neuro ICU). Here, a nurse will very carefully monitor your vital signs, including your blood pressure, heart rate, and oxygen levels.

Once the breathing tube is removed, a nurse will encourage you to perform deep breathing exercises with a device called an incentive spirometer. This will help prevent pneumonia.

You will be given pain medication, and depending on the surgery, other medications may be given as well. For example, Keppra (levetiracetam)—which is an antiseizure medication—may be administered after cerebral bypass surgery.

Once deemed ready by the surgeon, you will be moved to a regular hospital room. Here, the urinary catheter will be taken out and you will start getting out of bed to walk around. You will also slowly advance your diet from liquids to solids.

The surgical team will then help you get ready to go home or to a rehabilitation facility (to regain strength after surgery).

Precise at-home recovery instructions will depend on your condition and the type of bypass surgery you had.

Full recovery from vascular bypass graft surgery may take up to three months.

Some general recovery instructions may include:

  • Refrain from driving for three to eight weeks.
  • Refrain from sexual activity for four weeks.
  • If a vein graft was taken from your leg, raise your legs above your heart when sitting and avoid crossing your legs (to minimize swelling).
  • Remain out of work for six weeks (or longer if your job is physically demanding).
  • Follow-up with your surgeon as advised.

When to Seek Medical Attention

Your surgeon will give you specific guidelines for when to call or seek emergency care. General symptoms that warrant immediate attention include:

  • Fever or chills
  • Redness, swelling, bleeding, increased pain, or abnormal drainage from the incision site(s)
  • Breathing difficulties
  • Swelling in the calves or legs
  • Numbness, tingling, or weakness in any part of the body
  • Persistent nausea or vomiting

Long-Term Care

It's important to understand that while a complex and often life-saving surgery, vascular bypass graft surgery is not a cure for atherosclerosis. Therefore, you must strictly adhere to healthy lifestyle habits and take various medications to continue to prevent the progression of the disease.

Some of these key lifestyle habits include:

  • Smoking cessation
  • Consuming a healthy diet like the DASH diet
  • Engaging in a regular exercise program under the guidance of a physician
  • Controlling high blood pressure, high cholesterol, and diabetes with medication

Following up with your surgeon as advised is also crucial to long-term recovery. These visits allow the surgeon to monitor the bypass graft, check for complications, and ensure that you are moving forward on the right path in terms of healing.

A Word From Verywell

Vascular bypass graft surgery restores blood flow to vital organs and tissues like the brain, heart, and extremities. The surgery comes with risks, though, and the success of the operation depends on factors like the type of graft used, a surgeon's experience, your overall health status, and the severity of the disease being treated.

If you or a loved one are undergoing bypass surgery, be sure to carefully review all possible risks/benefits with the surgeon. Do not hesitate to ask questions and reach out for emotional support during this likely difficult time.

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Starr JE. Society for Vascular Surgery. Surgical Bypass.

  2. Michigan Medicine. Coronary Artery Bypass Surgery: Minimally Invasive Methods. Reviewed December 2019.

  3. University of California San Francisco. Coronary Artery Bypass Grafting.

  4. Shan L, Saxena A, McMahon R, Newcomb A. Coronary artery bypass graft surgery in the elderly: a review of postoperative quality of life. Circulation. 2013 Nov 19;128(21):2333-43. doi:10.1161/CIRCULATIONAHA.112.000729

  5. Vaidya Y, Bishop MA, Ludhwani D. Coronary Artery Bypass Graft Of The Gastroepiploic Artery. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Updated September 2020.

  6. Young J, Patel SK. Peripheral Vascular Bypass. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Updated August 2020.

  7. Anagnostopoulos A, Ledergerber B, Kuster SP, et al. Risk Factors for Incident Vascular Graft InfectionsOpen Forum Infect Dis. 2017;4(Suppl 1):S653. Published 2017 Oct 4. doi:10.1093/ofid/ofx163.1740. doi:10.1093/ofid/ofx163.1740

  8. American Heart Association. Symptoms and Diagnosis of PAD. Updated October 31, 2016.

  9. Michigan Medicine. Cardiac Surgery: Tests Prior to Surgery.

  10. Johns Hopkins Medicine. Coronary Artery Bypass Graft Surgery.

  11. Cleveland Clinic. Coronary Artery Bypass Surgery: Procedure Details. Reviewed June 2019.

  12. Johns Hopkins Medicine. Coronary Artery Bypass Surgery (CABG).

  13. University of Cincinnati. Cerebral Bypass Surgery. August 2011.

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