From the Guidelines
After lower extremity bypass revascularization surgery, patients should follow a comprehensive post-operative care plan that includes antiplatelet therapy with aspirin 100 mg daily and rivaroxaban 2.5 mg twice daily, as well as statin therapy, to reduce the risk of major adverse cardiovascular and limb events (MACE and MALE) 1.
Post-Operative Care Plan
The care plan should prioritize the following key components:
- Antiplatelet therapy: aspirin 100 mg daily and rivaroxaban 2.5 mg twice daily for patients with non-high bleeding risk following lower-limb revascularization 1
- Statin therapy: continued lifelong to maintain graft patency and reduce cardiovascular risk
- Regular ankle exercises and gradual increase in walking as tolerated
- Incision care: keeping the area clean and dry, watching for signs of infection, and attending follow-up appointments for suture removal
- Compression stockings: recommended during the day for 4-6 weeks to reduce swelling
- Elevation of the affected leg above heart level when sitting or lying down
- Smoking cessation: critical to reduce the risk of graft failure
- Blood pressure and diabetes management: vital for long-term success
Vascular Surveillance
Regular vascular surveillance with duplex ultrasound is typically scheduled at 1,3,6, and 12 months post-surgery, then annually thereafter to monitor graft patency 1.
Activity Level
Most patients can return to light activities within 2-4 weeks, but should avoid heavy lifting (over 10 pounds) for 4-6 weeks.
Additional Considerations
- Dual antiplatelet therapy with a P2Y12 antagonist and low-dose aspirin may be considered for at least 1 month after revascularization to reduce limb events 1
- Long-term dual antiplatelet therapy is not recommended for patients with PAD 1
From the Research
Post-Operative Recommendations
The following are post-operative recommendations after lower extremity bypass revascularization surgery:
- Antiplatelet therapy (APT) is recommended after interventions for lower extremity artery disease (LEAD) 2
- The type and duration of APT may vary, with clopidogrel being the most prescribed drug after certain interventions 2
- Dual antiplatelet therapy (DAPT) may be prescribed after certain interventions, such as femoral PTA with stenting 2
- Anticoagulation therapy may be prescribed after certain interventions, such as femoropopliteal and femorocrural venous bypasses 2
- The use of antithrombotic therapy, including antiplatelet and anticoagulation therapy, may vary depending on the patient's disease severity and comorbidities 3
Complications and Risks
The following are potential complications and risks after lower extremity bypass revascularization surgery:
- Deep venous thrombosis (DVT) is a potential complication after lower extremity bypass surgery, with certain factors increasing the risk of DVT, such as unplanned reoperation, reintubation, and urinary tract infection 4
- Postoperative complications, such as bleeding and deep wound infection, may increase the risk of DVT 4
- The use of antithrombotic therapy may help reduce the risk of DVT and other complications 4
Antithrombotic Therapy
The following are findings related to antithrombotic therapy after lower extremity bypass revascularization surgery:
- Single antiplatelet therapy (SAPT) is currently recommended for patients undergoing revascularization for chronic limb-threatening ischemia (CLTI) 5
- The use of DAPT or anticoagulation therapy may not provide improved outcomes compared to SAPT in certain patient populations 5
- The choice of antithrombotic regimen may depend on the patient's individual risk factors and comorbidities 3, 5