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Femoropopliteal Bypass Surgery

(Leg Artery Bypass Surgery)

Definition

In this surgery, the patient's vein or an artificial tube is used to create a bypass around a blocked main leg artery. The blocked arteries in the legs are usually caused by a buildup of plaque. When this buildup occurs, it is called peripheral arterial disease (PAD).
Femoropopliteal Bypass Graft
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Reasons for Procedure

  • To restore proper blood supply to your lower leg
  • To relieve leg pain caused by a blocked artery
  • To prevent the need for amputation

Possible Complications

If you are planning to have femoropopliteal bypass surgery, your doctor will review a list of possible complications, which may include:
  • Bleeding
  • Blood clots (eg, clots that causes blockage of bypass graft)
  • Infection
  • Adverse reaction to the anesthesia
  • Organ damage
  • Need for limb amputation
  • Heart attack or death
Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Your doctor will likely do the following:
  • Blood tests
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray —a test that uses radiation to take pictures of structures inside the body
  • Ultrasound—a test that uses soundwaves to make an image
Leading up to the surgery:
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
  • If advised by your doctor, take antibiotics to prevent an infection.
  • Arrange for help at home after the surgery.
  • The night before the surgery, have a light dinner. Do not eat or drink anything after midnight.

Anesthesia

You may be given:
  • General anesthesia (almost always used)—blocks pain and keeps you asleep through the surgery
  • Spinal anesthesia —the area from the chest down to the legs is numbed; given as an injection in the back

Description of the Procedure

The doctor will make a cut in the skin on the leg. Through this cut, the doctor will take out a vein that will be used to make the bypass. If the vein cannot be used, then an artificial vein is used.
Next, an incision will be made in the groin to expose the femoral artery. This is the artery in the thigh. The doctor will make another incision at the back of the knee to expose another artery. This is called the popliteal artery.
The doctor will use clamps to block the flow of blood through these two arteries. One end of the new bypass vein will be stitched into the femoral artery, and the other end will be stitched into the popliteal artery. Once attached, blood will be passed through the graft to check for leaks. If leaks are found, the doctor will repair them. The clamps will then be removed. This will allow blood to flow through the graft to the lower leg. The doctor will use stitches to close the incisions.
In some cases, a vein in the thigh will be used as a graft while left in place. This is called in situ. In this procedure, the valves inside the vein will be removed with a small scope and a small cutting tool. The vein will then be attached to the arteries to form a graft.

Immediately After Procedure

  • For the first 24-48 hours, fluids and pain medicines may be given by IV.
  • You may need to wear an oxygen mask for the first 10-12 hours.
  • An epidural in your back (to numb the site and relieve pain) may be left in place for the first 3-5 days. Once this is removed, your doctor will give you pain medicine.

How Long Will It Take?

1-3 hours

How Much Will It Hurt?

As you heal and the swelling in your leg subsides, you may have pain for weeks or even months. Ask your doctor about medicine to help with the pain. Keep in mind that it is normal for your leg to remain swollen for 2-3 months.

Average Hospital Stay

7-10 days

Post-procedure Care

At the Hospital
While you are recovering at the hospital, you may be instructed to:
  • For the first 1-2 days, use cold packs to decrease pain and swelling. A nurse will apply a cold pack to the area for 15-20 minutes each time.
  • You may wear boots or special socks to help prevent blood clots
  • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
  • Your incision will be examined often for signs of infection.
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Do not drive for 4-6 weeks, or until you are pain free.
  • If advised by your doctor, walk every day. Walking will make your legs stronger. Slowly increase how far you walk.
  • Work with a physical therapist.
  • Slowly increase the activity you do each day.
  • When sitting, keep your legs elevated.
  • Place a pillow under your leg when sleeping.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Keep the wound dry. Avoid using talc or powder.
  • Avoid fatty foods.
  • Do not smoke. Smoking can interfere with healing.
  • Be sure to follow your doctor’s instructions .

Call Your Doctor

  • Signs of infection, including fever and chills
  • Severe pain in the leg
  • Your leg becomes cold, pale, blue, tingly, or numb
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea, vomiting, or constipation
  • Pain that you cannot control with the medicines you have been given
  • Cough, shortness of breath, or chest pain
  • Dizziness or weakness
  • Pain and/or swelling in your feet, calves, or legs
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • New, unexplained symptoms
In case of an emergency, call for medical help right away.

RESOURCES

American Heart Association http://www.americanheart.org/

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/

References

MacVittie B. Mosby's Perioperative Nursing Series: Vascular Surgery. St. Louis, MO: Mosby; 1998.

Rothrock JC, Smith DA, McEwen DR. Alexander's Care of the Patient in Surgery. 11th ed. St. Louis, MO: Mosby; 1999.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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