Peripheral Artery Bypass for Popliteal Artery Entrapment Syndrome: An Overview

Introduction:

Popliteal artery entrapment syndrome (PAES) is an uncommon vascular disease affecting the main blood vessel (popliteal artery) situated behind the knees. The condition more often occurs in active males. In this condition, the calf muscles present behind the knees are usually larger or abnormally placed, compressing the popliteal artery and reducing the blood flow to the lower leg. The condition is characterized by pain, cramping, and numbness in the legs and feet, which usually occurs during exercise and vanishes three to five minutes after the exercise is stopped. During exercise, the muscle compresses the artery and reduces the blood flow. This reduced blood flow results in the accumulation of lactic acid in muscles and nerves, which causes pain and numbness in the legs and feet.

For asymptomatic patients with an accidental finding of popliteal artery entrapment syndrome, the treatment is usually conservative. Since most of these patients do not suffer any symptoms or disease progression. However, surgery is preferred if muscle insertion abnormalities cause PAES, even in asymptomatic patients. Moreover, surgery has been the preferred course of treatment for symptomatic patients. One of the surgical repairs for treating PAES is a peripheral artery bypass. If the entrapped artery is severely narrowed or blocked due to muscle compression, bypass surgery is required to restore normal blood flow to the legs. This article discusses the role of peripheral artery bypass surgery in managing PAES.

What Is Peripheral Artery Bypass Surgery?

Peripheral artery bypass is a surgical procedure to reroute the blood supply around the narrowed or blocked blood vessels in the legs. In this procedure, a graft is used to replace the blocked or narrowed part of the artery. This graft can be a plastic tube or a part of a blood vessel taken from other parts of the body during the same procedure.

The peripheral artery bypass procedure involves the following steps:

1. Anesthesia: Before surgery begins, general anesthesia is given, making the patient unconscious to ensure pain-free surgery. Depending on the preferences, instead of general anesthesia doctors may use epidural or spinal anesthesia that is injected into the spine with medication, which makes the lower part of the body numb.

2. Incision: Once the anesthesia is gained, the surgeon cuts an area between the groin and the knee. This allows access to the blocked or narrow section of the artery. After the damaged part of the artery is located, the surgeon will cut the part of the artery that is damaged.

3. Clamping and Graft Placement: The surgeon then places clamps at each end of the blocked artery to temporarily stop the blood flow. The graft is then sewn.

4. Closure of the Incision: After the successful artery bypass, the incision is closed by using a stitch or stables. The wound is then closed with a sterile dressing material.

5. Arteriogram: In some cases, an arteriogram is done– a type of X-ray to verify that the graft is working properly.

What Steps Are Recommended Before Peripheral Artery Bypass Surgery?

There are several recommended steps to be followed before surgery to reduce the risk of complications. These steps are as follows:

1. Pre-operative Assessment:

• Physical Examination and Medical Tests: Before surgical procedures, individuals undergo physical examination and medical tests to know their overall health state. Individuals need to get their hearts and lungs checked before the surgical procedure to ensure they are fit for the procedure.

• Managing Medical Conditions: In the case of diabetic patients, blood sugar levels must be managed well.

• Reviewing Medication: Always inform the doctor what medicines one is taking, including drugs, herbs, or supplements.

2. During the Two Weeks Before Surgery:

• Stop Blood Thinning Medication: If taking any blood thinning medications for any underlying medical issue, such as Aspirin, Ibuprofen, or any other similar drugs. The doctor might ask to stop the medication, as these drugs cause a delay in clot formation.

• Smoke Cessation: One needs to stop cigarette smoking as it can impair blood circulation and delay wound healing.

• Inform the Doctor About Communicable Diseases: Inform the doctor about the illness one gets before surgery such as cold, fever, herpes breakouts, or other diseases.

3. On the Day of Surgery:

• Avoid drinking and eating after midnight the night before surgery, including water.

• Take the medicines only as instructed by the doctor, with a small sip of water.

What to Expect After Peripheral Artery Bypass Surgery?

• After the surgery is done, the patients are immediately sent to the recovery room where nurses will be attentively monitoring them. Following this, the individuals are sent either to the Intensive Care Unit (ICU) or standard hospital room. The average hospital stay lasts four to seven days.

• Patients will be allowed to move from bed once the surgeon approves. The surgeon will gradually expand the walking distance. When sitting on the chair, legs should be kept elevated on a stool or other chair.

• Following surgery, there will be a regular check on the pulse. Because the success of peripheral artery bypass surgery is determined by the pulse strength. In case one experiences any new symptoms on a surgically repaired leg like numbness, paleness, or color change. One should immediately inform the healthcare professional.

• Pain medications are given as needed to manage the discomfort after surgery.

What Are the Complications of Peripheral Artery Bypass Surgery?

Several complications may arise after peripheral artery bypass surgery. However, not everyone who undergoes surgery will experience these complications.

• Allergic reactions to medications.

• Difficulty in breathing.

• Heart attack.

• Blood clots.

• Nerve damage.

• Uncontrolled bleeding.

• Infection within the surgical wound.

• Leg amputation.

What Is the Prognosis After Peripheral Artery Bypass Surgery In PAES?

The overall prognosis of peripheral artery Bypass surgery in PAES patients is good. For most individuals, surgery results in improved blood flow within the arteries.

Conclusion:

Peripheral artery bypass surgery proves to be an effective surgical treatment for patients with popliteal artery entrapment syndrome experiencing pain and numbness in the feet and legs due to compression of the blood vessels. Peripheral artery bypass surgery relieves pain and improves the quality of life by restoring blood flow to the lower extremities.