Surgeon Anne Burdess’ patient is 66-year-old retired legal secretory Lynne. She has had surgery before to bypass a blocked artery, but the problem has returned.
Lynne has been experiencing a lot of pain in her foot, which has increased for the last two weeks leaving her unable to sleep: “I can’t walk very far, because I can’t stand for any length of time. I go upstairs on all fours because I cannot feel my feet and there is a danger of me missing a stair. I am virtually on the sofa all day.”
Lynne is starting to get symptoms of critical leg ischemia, this is when there is pain when the leg is not moving. This can progress when there is pain all the time with rest pain. Anne will perform a repeat bypass, harvesting a vein to add a new pipe to move blood down the leg.
“If this progresses, the blood supply is compromised so much and the tissue starts to die off and could lead to a major amputation.” Anne explains.
Lynne is taken to the vascular lab to see where the best vein can be taken from her other leg.
If the pain was to progress in any way, she will get overwhelming infection which can be life threatening.
Anne starts by exposing the vein in the leg, this vein will be removed to bypass the clogged artery to restore the blood supply from the foot.
“We always scan a patient before to find the best vein. It is only when we expose the vein during the operation if we know it is good enough for the bypass.
“All of the ties of the vein have to be okay, or there will be bleeding along the bypass. You have to be careful during harvesting to not cut into it,” Anne adds.
This is painstaking work, any leaks in replacement vein will make it ineffective.
As Anne explains: “We need to to be at least 3mm wide. It needs to be a big enough pipe to carry high pressure arterial blood, smaller than this it is more likely to fail. The length of the vein is important, as we might not have enough length of vein. If it is too short, the more joins in the vein, the more chance of failure.”
Anne is at a crucial part in the operation, she is checking the length of vein she needs to carry the blood supply to Lynne’s foot. If the vein is too short, a second will need to be found to form an extension, but will increase the chance of complications.
Anne checks the vein for any holes and leaks, by flushing it through with water, she stiches any holes in the veins up.
Carefully, Anne stitches up the join making it as smooth as possible to stop any clots forming, checking for any leaks in the join.
Once the vein is attached, the vein is flushed to make sure no clots have formed during surgery. The clamps are released to restore blood flow to Lynne’s foot.
Using an ultrasound Doppler, Anne checks the blood flow from the graft, and below the join to check the blood supply to the foot.
The sound is good, and the icing on the cake for Anne is that the foot is pinking up nicely, which indicates a good flow of blood.
The blood flow to Lynne’s foot has improved, but unfortunately she fractured her other foot.
