Vascular Surgery/Fem pop

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Question
I am now 3 weeks post fem pop and last week had the staples removed and the surgeon said pulses were good and all looked good. This week my foot and lower leg are swollen and turn pink when I walk. I am in excellent general health except for large cell vasculitis which caused ischemic nerve involvement in my foot and lower leg before the surgery but has been under control with prednisone. What are the symptoms of a failed graft?

Answer
this sounds like reperfusion edema not a failed graft  the following is part of an earlier reply to anther person about this issue:

there is an postoperative event that is called reperfusion edema, means swelling after bypass.   during the months/years before surgery the bloodflow has been diminished, when bloodflow is increased due to a good bypass, the  leg is suddenly getting way more blood (a fluid) than it has had in a long time.  You cant stop it because it is a direct result of the bypass.   This increased bloodflow is what makes the leg feel better when you walk or sleep, heal  any  wounds, makes your skin more supple, increases the fat pads on the sole of your foot.  it does all kinds of good things and for that increased bloodflow you have to alter your daily routine for a few weeks.

first though,  i suggest you let your surgeon know this is happening and ask if these are acceptable interventions from his point of view, because you aren't a patient of our clinic, so i can only give general information to reduce swelling. Also ask him or his nurse what the schedule is for your bypass scans in the future. at our clinic we do an ultrasound to assess the status of the bypass- we do ultrasound at 1 month, 3, 6, 12, 18 months post op and then annually or twice yearly depending on the function of the bypass.

by keeping an eye on the bypass w/ ultrasound scan, it is possible to prevent narrowing of your bypass- recurrence is possible for a variety of reasons- progression of disease can diminish the function, even block it off totally- once blocked, it is less likely to be fixed with a minimally invasive technique like angioplasty or lysis (open up with bloodthinning IV medications...{i know you did not mention smoking, but i just had to get this in}    if for any reason you are smoking- the odds are wicked high, like almost 100%, that the bypass WILL block off and block off fast.  some docs won't re-do a bypass in a patient who continues to smoke. Anyway…

reperfusion edema can last from a few days to a few weeks.  IF your doc says it is ok you can use a MILD compression stocking one that is like 10-12 or 15 to 20 mm pressure, if there is an incision along the knee, you may not be able to wear this stocking but could use an acewrap.  if your docs says it is OK then you have to put this stocking #or acewrap) on BEFORE you get out of bed, i know this sounds like a hassle but if you put them on before you get out if bed -dont even get out to make coffee, go to bathroom anything- set your alarm a few minutes ahead and shower at night if you have to. compression cannot correct swelling, it can only be prevented with compression, when you have been in bed all night, your legs are the skinniest they will be all day, by putting them on now, you won't have the edema you have now.  you can get mild compression at a drug store or medical supply company or even online, you want a 8-12 mm or 10-20 millimeters of pressure.  this is the one you must ask the doc about because compression is contraindicated ion patients with arterial bypass because it too tight they can actually decrease the bloodflow- dont let that scare you just ask and do as he says.

the other thing is to elevate during the day if you can, if you can't then, instead of standing or sitting still,  while sitting
  activate the muscle pumps in your calf and foot by: do some ankle flexes -point toes out towards the wall and hold a few seconds then to point to your face..and raise heel off floor then raise up so the ball of your foot is extended, like a half tiptoe stance-and repeat- this will push the blood back up to the heart through the veins, these "pumps in the foot and calf are the only physiologic system to return blood to the heart, so it will make a difference.

   when standing shift your weight from foot to foot, do some toetips again and exercise that calf muscle. when home again, raise / elevate the leg some- but be aware elevation especially at night while in bed can make your leg feel worse , just lying in bed is better than elevated UNLESS YOUR DOC said to do it.    take your stocking off when ready to get ready for bed, put on again in the AM before you get out of the bed.  i think that you will do better with some of these ideas, but before you implement them be sure to call his office and ask him or his nurse.
best of luck lauri  

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Lauri Ordway

Expertise

I can answer your questions related to your circulation, your peripheral vascular system. This includes all arteries and veins except those inside the head and inside the heart. For example, neck (carotid), arms (carotid subclavian bypasses to Thoracic Outlet) belly (aortic aneurysm & occlusive disorders, renal artery stenosis), legs (iliac, femoral, popliteal, peroneal, dorasalis pedis, posterior and anterior tibial) arteries. Aneurysm & occlusive disease, atherosclerosis, leg pain, arterial wounds and gangrene, amputation prevention. Arterial Bypass, Reynaud’s, Buerger's disease (thromboangiitis obliterans), Thoracic Outlet and other circulation disorders. Vein disorders: Blood Clots (DVT), post-phlebetic syndrome, varicose veins, venous stasis ulcers. I can help with vascular wounds from diagnosis to treatments. I have worked extensively with VNUS Closure and EVLT (Laser) for varicose veins and can describe pre and post procedure expectations and describe the procedures themselves. I can't help with spider veins or cosmetic vein treatment, we don't do it. I have 15 years of wound care experience, arterial, venous, trauma and diabetic wounds for example. **I CANNOT answer questions about STENTS or STENTING, heart disease, blood pressure, brain aneurysm although I can help with questions about the arteries that go to and from those organs.

Experience

I am a nurse, I worked for 15 years with two terrific peripheral vascular surgeons, and one of them is also the inventor of very innovative wound care products and surgical instruments to make vascular surgery procedures better and faster. I wrote and manage the clinic website and field questions from patients all over the world. I am now working with another vascular surgeon and wound care expert, which has given me an opportunity to widen my horizons as I learn another excellent physician's preferences and benefit from his experiences in this amazing specialty.

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I am an LPN, licensed in Minnesota

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