What Is a Vascular Graft?

A Procedure That Redirects Blood Flow

In This Article

A vascular graft (also called vascular bypass) is a surgical procedure that redirects blood flow from one area of the body to another by reconnecting the blood vessels. Vascular grafting is most commonly done to bypass a complete or partial blockage in an artery in order to improve blood flow to the organ supplied by the diseased artery.

Vascular grafts are most commonly used in the heart during a coronary artery bypass or in the legs to help treat vascular disease and poor blood flow.

Purpose of Vascular Grafts

One of the major causes of getting a vascular graft is in cases of cardiovascular disease, which is the leading cause of death worldwide. An example of this would be peripheral artery disease (PAD), which is when narrowed arteries in the limbs reduce and restrict blood flow from circulating throughout. In order to determine if a vascular graft is the best course of action for a patient, your doctor will run a series of tests first.

Coronary Heart Disease

A large majority of cardiovascular diseases are caused by the narrowing or blockage of blood vessels, which reduces blood flow and results in tissue damage from lack of nutrients and oxygen which is carried in the bloodstream. In the case of coronary heart disease, plaque buildup from a sedentary lifestyle, high blood pressure, high cholesterol, diabetes, or habits such as smoking causes coronary arteries (which supply blood to the heart) to narrow.

Symptoms include chest pain, shortness of breath, and in extreme cases, heart attack. If your doctor suspects you have coronary heart disease they will run a series of test, such as:

  • electrocardiogram (ECG) to record electric signals as they travel through the heart
  • echocardiogram to monitor how effectively your heart is pumping
  • stress test to measure blood flow during periods of activity
  • angiogram, which is done by injecting a special dye into the heart to point out narrow arteries or blockages
  • heart scan which can help doctors determine if arteries are being blocked by calcium deposits

The treatment of CAD includes lifestyle changes and medication. If these are insufficient, angioplasty and stenting are usually the next options. Vascular grafting is considered when a stent is infeasible (because of the severity of disease) or when it has failed.

Cerebrovascular Disease

Most commonly referred to as a stroke, cerebrovascular disease happens when the blood flow to the brain is obstructed, resulting in brain cells not getting enough oxygen and becoming damaged. This can happen due to age, heredity conditions (such as a grandparent who suffered from strokes), or poor lifestyle habits.

To confirm whether or not a patient will have cerebrovascular disease a doctor will run tests such as:

  • angiogram, which will use a special contrast dye in order to monitor hard-to-see arteries in the body and determine if there are any blockages in ones that supply blood to the brain
  • carotid ultrasound to determine if there is any plaque build-up in the carotid arteries, the major blood vessels in the neck that supply blood to the brain
  • computed tomography (CT scan) to examine the arteries and confirm whether or not a stroke has occurred in the brain
  • ultrasound to examine the health of certain arteries and veins
  • electroencephalogram (EEG) which uses small metal discs placed on the scalp to pick up brain waves
  • lumbar puncture, which is a more invasive test that helps determine if the brain has hemorrhaged and is actively bleeding
  • magnetic resonance imaging (MRI) which helps produce a 3D image of the brain to pinpoint any signs of stroke

Once your doctor determines the cause of stroke, she will determine the best course of action to help restore blood flow to the brain.

In some cases, such as vascular malformations that are causing restricted blood flow, your doctor will use a vascular graft to assist with poorly formed arteries and veins.

Peripheral Artery Disease

This common condition happens when narrow arteries restrict blood flow to the limbs and can be a sign of plaque buildup in arteries elsewhere in the body (such as the heart or neck). Symptoms of PAD often include leg weakness or numbness, sores on toes or feet that won’t heal, slower toenail and leg hair growth, or a weak pulse in legs and feet. Exercise-induced leg cramps (claudication) is another major symptom of PAD.

Lifestyle factors are often the cause including smoking, obesity, diabetes, high blood pressure, high cholesterol, as well as age and family history. If your doctor suspects you are suffering from PAD, he will conduct a series of tests after an initial physical exam including:

  • ankle-brachial index (ABI), which compares the blood pressure in your ankle versus your arm
  • ultrasound to examine blood flow in the limbs
  • angiography to view blood flow through the veins of the affected limb
  • blood test to measure cholesterol, triglycerides, and check for diabetes as PAD is often a side effect of the disease

Once diagnosed with PAD, your doctor will determine the best course of treatment which may involve bypass surgery or using a vessel from another part of the body or from a man-made, synthetic vessel to move blood flow around the blocked artery.

Risks and Contraindications

Risks of grafting that are the most common include bleeding, clotting of the grafted artery, and (with coronary artery grafting) cardiac arrhythmias. Another risk sometimes associated with a vascular graft procedure of any kind is the possibility of infection. Particularly if the patient has preexisting health conditions, the risk of infection can increase—this includes both wound infection and bacterial infection resulting in pneumonia or infection of a targeted organ.

It’s important to give your doctor a thorough health history so she can be aware of all of the potential risk factors.

Other factors that contribute to infection risk include how long the procedure is and the type of surgery being performed. A past study published in the journal Open Forum of Infectious Disease that studied risk factors for vascular graft infections saw a cumulative infection incidence rate of approximately 6 percent of subjects studied.

Depending on the condition of the patient, if surgery is too risky, a doctor may not perform vascular graft and opt for a stent or perform an angioplasty—a minimally invasive procedure that uses a balloon to widen an artery instead of redirecting blood flow completely.

How to Prepare

Once you and your doctor agree that a vascular graft is the best option, any harmful lifestyle habits should cease immediately. Stop smoking and follow a healthy diet that is filled with fruits, vegetables, and whole grains. If you’re seeing other specialists, your surgeon may want you to get his approval before surgery, which will require you to make the necessary appointments and tests to do so.

In the days before surgery, follow your normal routine unless otherwise outline by your doctor. Get plenty of rest and follow any instructions about medication and food as directed—you may need to stop taking certain prescriptions and fast starting at midnight the night before surgery.

What to Expect

All vascular grafts, no matter what type of disease they are treating, are surgical procedures that are approximately one to six hours in length, depending on the severity of the condition. The surgery will require on average a two- to five-night stay in the hospital. Depending on the location of the artery grafted and the type of graft used—whether from another artery or a synthetic graft—your doctor will have a very specific post-op plan for you.

In general, you should plan to rest once you get home from the hospital, slowly building up your activity level each day until you meet with your doctor for follow-up appointments.

The incision site may also be sore several days after the surgery and you should follow your specific wound care and pain management plan, depending on whether or not you have stitches, staples, or Steri-Strips over the incision site. You will likely have to wait several days to shower and get the incision wet. Most doctors recommend having a support system at home once you get home from the hospital to help you move around and keep you comfortable.

Preparing for the Procedure

Prior to surgery, you will have a pre-admission visit a week or two before where you'll fill out paperwork, get certain tests such as X-rays, blood tests, and an electrocardiogram (ECG) to check your heart. The nurse will go over any directions you'll need to follow before surgery, including when to stop eating and drinking and what medications you can or cannot take. The anesthesiologist will also go over any anesthesia that will happen for the surgery and discuss pain management after the surgery is completed.

The day of the procedure, you should expect to arrive about two hours before surgery. Your surgical team will help you change into a gown and get your IV ready, which will deliver fluids and medication both during and after the procedure. You'll then wait in a holding area until the surgeon is ready for the procedure.

During the Procedure

The surgeon will use prior imaging and tests to help locate the area that needs the vascular graft and see how damaged the blood vessels are in the surrounding area. After making an incision in the area where the blockage is, the surgeon will make a cut in the artery that is blocked, moving skin and tissue out of the way and then placing clamps at each end of the blocked artery section before sewing a graft in.

The surgeon will then make sure there is good blood flow through the graft before sewing the incision back up. Once the surgery is done, you'll be wheeled into a recovery area to be monitored before being moved into your hospital room where you'll stay for a few nights.

Longevity

How long a graft holds up depends on the overall health of the artery, type of graft used, and health and lifestyle factors such as whether or not your smoke, have diabetes, or suffer from other preexisting conditions that may cause stress on the veins and arteries.

A Word From Verywell

It’s important to remember that a vascular graft is not a cure for a disease or blockage. The procedure simply provides a detour to help the blood move throughout the body with the least amount of resistance so that oxygen and nutrients are delivered to vital organs such as the heart, lungs, and brain. Other treatment options are typically explored first, such as lifestyle changes, stenting, and in some cases angioplasty. 

Was this page helpful?
Article Sources