The main artery which carries blood down your leg is blocked just above the knee. The calf, foot and toes are starved of blood. This causes pain and can lead to serious infection and loss of the limb. The blocked part of the artery can be bypassed so that blood flows properly again.
You will have a general anaesthetic, and will be asleep for the whole operation. One or two cuts are made in the skin down the inside of the thigh so that the artery above and below the block can be seen. A bypass tube (vascular graft), made of vein (a superficial vein that lies under the skin which is taken if possible from one of your legs at the same time as the bypass operation) or a special plastic, is stitched into the artery above and below the block. The blood then flows down the bypass towards the toes. The skin wound(s) are then closed up. Usually after a week or so you will feel fit enough to leave hospital provided there is someone to look after you and the wounds are healing well.
If you do nothing your lower limb problems will surely get worse. An injection into the nerve in your back that controls the artery will not help. The blocked artery is not suitable for coring out using lasers or X-ray controlled balloons. Antibiotics and other drugs will not help by themselves. An amputation is not something to have done instead of the bypass operation. However, dead tissue may need to be trimmed away after a bypass operation.
Before the operation
Stop smoking and try to get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.
On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You will have a fine, thin plastic tube in an arm vein to give you a transfusion of blood or salt solution. There may be some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is not well controlled or if it gets worse. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time. You will most likely be able to get out of bed with the help of the nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The third day after the operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually pain-free. It is important that you pass urine and empty your bladder within 6 to 12 hours after the operation. If you cannot pass urine let the doctors and nurses know and steps will be taken to correct the problem.
There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after two to three days. This is expected and you should not worry about it. There may be some swelling of the surrounding skin which also improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line, but these settle down after discharging a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been removed. Try to keep the wounds dry until the stitches/clips come out which is usually 10 to 14 days after the operation. If there only stitches under the skin, try to keep the wounds dry for a week. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave the hospital. The nurses will advise about sick notes, certificates etc.
The wound has a dressing which may show some staining with old blood in the first 24 hours. You can take the dressing off after 48 hours. There is no need for a dressing after this unless the wound is painful when rubbed by clothing. There may be stitches or clips in the skin. The wound(s) may be held together underneath the skin with stitches that are dissolvable and don’t need to be removed. There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after two to three days. This is expected and you should not worry about it. There may be some swelling of the surrounding skin which also improves after two to three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been removed. Try to keep the wound(s) area dry until the stitches/clips come out which is usually 10 to 14 days after the operation. If you just have stitches inside the wound(s), try to keep the wound(s) dry for a week. Soap and tap water are entirely adequate. Salted water is not necessary. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave hospital. The nurses will advise about sick notes, certificates etc.