Femoropopliteal Bypass Surgery

(Leg Artery Bypass Surgery)

Definition

During femoropopliteal bypass graft surgery, a 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    TOP

Femoropopliteal bypass graft may be done to:

  • Restore proper blood supply to your lower leg
  • Relieve leg pain caused by a blocked artery
  • Prevent the need for amputation

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Blood clots
  • Infection
  • Adverse reaction to the anesthesia
  • Organ damage
  • Need for limb amputation
  • Heart attack or death

What to Expect    TOP

Prior to Procedure

Your doctor will likely do the following:

  • Blood tests
  • Electrocardiogram (EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray
  • Ultrasound

Leading up to the surgery:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • 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 —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    TOP

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    TOP

After the procedure you may be given:

  • Fluids and pain medications by IV for the first 24-48 hours.
  • 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.

How Long Will It Take?    TOP

1-3 hours

How Much Will It Hurt?    TOP

As you heal and the swelling in your leg subsides, you may have pain for weeks or even months. Pain can be managed with medications. Keep in mind that it is normal for your leg to remain swollen for 2-3 months.

Average Hospital Stay    TOP

7-10 days

Post-procedure Care    TOP

At the Hospital

While you are recovering at the hospital, you may be instructed to:

  • Use ice packs to decrease pain and swelling. A nurse will apply a cold pack to the area for 15-20 minutes each time.
  • Wear boots or special socks to help prevent blood clots.
  • Use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
  • Watch the wound for signs of infection.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home

It may take up to 4-6 weeks (or sometimes longer) to feel pain free. If advised by your doctor, walk every day to make your legs stronger. You may be referred to a physical therapist to help with exercises. At home, you will need to take care of the wound to prevent infection. Your doctor may advise lifestyle changes, such as quitting smoking and a healthy diet.

Call Your Doctor    TOP

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, 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
  • Lightheadedness 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

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

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

References:

MacVittie B. Mosby's Perioperative Nursing Series: Vascular Surgery. St. Louis, MO: Mosby; 1998.
Rothrock JC, Smith DA, et al. Alexander's Care of the Patient in Surgery. 11th ed. St. Louis, MO: Mosby; 1999.
Last reviewed December 2014 by Michael J. Fucci, DO
Last Updated: 12/20/2014