Bypass (medicine)

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A bypass is an operationally created bridging of a passage obstacle. This creates a new connection between the beginning and the end of a bottleneck ( stenosis ). A bypass surgery colloquially usually an operation on the heart, in the highly narrowed or completely occluded coronary arteries are bypassed to the sufficient blood supply to the heart muscle recover.

In contrast, the generation of extracorporeal circulation by a heart-lung machine is referred to as cardiopulmonary bypass .

Applications

Different numbers of bypasses

Bypasses are most commonly performed in vascular surgery , for example to treat the end stage of so-called intermittent claudication ( peripheral arterial occlusive disease - PAD) or an aneurysm . In cardiac surgery , for example, coronary artery bypass has been used in coronary artery disease (CHD) since the 1960s .

In a bypass operation, veins and / or arteries are removed from your own body or from the deceased and used to bridge the constriction. Synthetic fabric bypasses (e.g. Gore-Tex ) are also used. In vascular bypass operations, mostly artificial vascular prostheses , but also veins as the body's own material, are used. Artificial shunts and anastomoses are also created.

It can be clearly demarcated when artificial prostheses and when the body's own veins or natural donor vessels are used: In interventions in which, for example, an aorta is completely replaced, there would not be a sufficiently large vein in the body. Tubular prostheses "can be used, as well as when occlusions of the pelvic arteries are treated (e.g. with a Y-prosthesis). Prostheses can also be used on the thigh without any major problems. However, if the bypass is relocated through the knee (even if this is done extra-anatomically!), A vein is used if possible, as the risk of occlusion is very high due to the extreme loads caused by shear forces etc. However, if none of the veins can be removed, because either all of them have already been "used up" or there is extreme varicosis , a ring-reinforced prosthesis is usually used to keep the lumen open at all times.

Endarterectomies are often performed on the common carotid artery . A complication here is a primary ischemic cerebral infarction , the risk of which is to be reduced by this operation. Blocked arteries or blocked bypasses can sometimes be saved with a thrombectomy or with a stent (see also angioplasty ).

But also in other operative areas one speaks of a bypass operation, for example when a constriction in the intestine due to a tumor is treated with a short circuit operation. Here, the intestine in front of the constriction is sewn to the intestine after the constriction. A Roux-en-Y gastric bypass , in the bariatric surgery are also applied to weight loss.

As an alternative to a bypass, an implant can also be used as an interposal in vascular surgery, i.e. as a replacement for the vascular section affected by the passage obstacle. The choice between graft and bypass depends on various factors such as the location and extent of the damage and the type and size of the affected vessel.

rehabilitation

After an inpatient bypass operation, medical rehabilitation usually takes place. Often this takes place in a rehabilitation clinic. Outpatient rehab is only possible in mild cases, as the patients must be resilient enough for this. The aim of the rehabilitation measures is to avoid another heart attack. To this end, the patient is treated by doctors, psychologists or physiotherapists and trained in health training. The areas of nutrition and exercise in everyday life are also essential components of rehab after bypass surgery.

reception

The poet Robert Gernhardt wrote the entire cycle of poems Herz in Not about his bypass operation .

See also

Web links

Wiktionary: Bypass  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. Reinhard Larsen: Anesthesia and intensive medicine in cardiac, thoracic and vascular surgery. (1st edition 1986) 5th edition. Springer, Berlin / Heidelberg / New York a. a. 1999, ISBN 3-540-65024-5 , pp. 79-120; here: p. 80.
  2. ^ Susanne Hahn: Bypass. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 223 f.
  3. Robert Gernhardt : Heart in Need . S. Fischer Verlag, Frankfurt am Main 2004, ISBN 3-596-16072-3 .