Upper Extremity Bypass

What to expect with your surgical procedure

Upper extremity bypass grafting includes procedures such as axillary (chest/arm pit) to brachia! artery (upper arm) bypass grafting. This procedure is used to treat arm pain caused by arterial blockage or occlusion in the arm arteries. The operation usually takes about 1-2 hours if a vein from your own body is used for the graft. Using a synthetic graft takes less time but is only used when a vein is not available or when vein is not the best choice for the bypass. The vein used most often is taken from one of your legs.

Recovering from the procedure

Usually, you will be discharged from the hospital within 2 days. Pain should be adequately controlled in the hospital with IV and/or oral medication. You will be given a prescription for pain pills when you leave the hospital. It is not uncommon to have some redness and swelling in the area where you had your surgery. The redness should gradually fade, and the swelling should be kept to a minimum by resting in between activities with the affected arm elevated at or above the level of your heart (in a recliner, or on a couch or bed). You should not carry anything heavier than a gallon of milk while your wounds are healing. You should walk regularly and gradually increase activity, but know that until you are completely healed, increased activity will increase swelling. The more you can elevate the affected arm between activities, the less swelling you will have. Elevation will make it less likely that you will suffer from possible wound complications such as seroma (the collection of lymph fluid that can cause good-sized lumps under the skin near incision lines), fluid drainage, and infection. Smoking also increases your risk of having complications, as does having diabetes. Postoperative complications increase your chances for having graft thrombosis which is a partial or complete loss of blood flow through the graft. The most common postop complication is swelling with fluid drainage which can be straw-colored like urine, pink, or even red-brown like old rusty blood. Other potential complications include bleeding, infection and graft thrombosis.

You should call the doctor immediately

  • if your surgical site becomes so swollen it is difficult to use your arm, or
  • if the swelling increases suddenly (over a few minutes)
  • if you have any symptoms of loss of circulation to your hand such as loss of a graft pulse, cold or discolored hand, and increased pain.
You should also notify your physician if you experience any signs or symptoms of infection, including:
  • redness that gets worse rather than better,
  • drainage from the wound that is like pus, and
  • fever greater than 100.
You should arrange a follow up appointment with the doctor 10-14 days following surgery for staple/suture removal. You may need to call the office to arrange an appointment time. Once the incision line has healed completely, using a vitamin E ointment or a moisturizing cream may help reduce scarring.

You may notice some numbness along your incision line, or even some strange sensations with use after surgery. This is not uncommon and often will resolve within a few weeks after surgery. Sometimes the numbness can last for months, and in some cases, may not go away. This is due to the unavoidable disruption of the nerves along the incision lines.

Your activity restrictions are minimal. If you drive, you may resume driving 1 week following surgery, as long as you are no longer taking pain pills and can comfortably move as needed to drive. After 1 week, you may gently begin to return to your normal range of motion.

You may shower 72 hours after surgery, and pat the incision lines dry.

You should expect to take one enteric-coated aspirin (EC aspirin) every day from now on unless specifically instructed to do otherwise. Taking 1aspirin a day (or the prescribed alternative) will help the graft(s) stay open and reduce the chances that you will need additional vascular surgery in the future. Sometimes Warfarin/Coumadin® or anti-platelet medications like Ticlid or Plavix are required, especially when a synthetic graft is used.