Aortoiliac and Aortofemoral Bypass Graft Surgery
by Rosalyn Carson-DeWitt, MD
In a bypass, artificial tubes (grafts) are placed near a section of the blood vessel that is blocked or narrowed. The graft creates a path so that blood can move around the blockage. In this case, the grafts are placed on the aorta, and the iliac or femoral arteries.
The aorta is the major artery that leaves the heart. It brings oxygen-rich blood to the body. At about the level of the belly button, the aorta divides into two iliac arteries. At the level of the groin, the iliac arteries become the femoral arteries.
Aortofemoral bypass is also called aortobifemoral bypass. This is because the graft is formed in the shape of an upside down "y."
Most bypass surgery involves a traditional, open incision. Research is being done on how to do these operations through laparoscopic or mini-laparotomy techniques. They use much smaller incisions.
Reasons for Procedure
To have good blood flow to the lower part of the body, there must be good blood flow through the aorta, the iliac arteries, and the femoral arteries. Atherosclerosis is a disease in which sticky patches (plaques) build up along the walls of blood vessels. These plaques block the normal flow of blood within affected blood vessels. When the blood flow is decreased, the tissues on the other side of the blockage do not receive enough oxygen. This can result in the following:
This surgery can restore blood flow to the legs.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
Your doctor may do the following:
Leading up to your procedure:
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
Description of the Procedure
A large incision will be made in your abdomen. The muscles around your abdomen will be cut. To get to the blood vessels, some organs will need to be carefully moved out of the way.
Blood flow through the vessels will be briefly stopped. Clamps will be placed on either side of the blocked area to stop blood flow. The graft will be sewn into place. One end of the graft will be attached to the aorta just above the blockage. The other end will be attached just after the blockage on the femoral or iliac arteries.
The clamps will be removed. The doctor will watch to make sure there is good blood flow through the graft. Your internal organs will be put back into place. The abdominal muscles will be pulled together. The muscles will be stitched closed. The skin incision will be closed with either sutures or staples.
After the surgery, you will be brought to a recovery room. The tube in your throat may be removed, or it may need to stay in for a few days. The epidural anesthesia may also be continued for a few days. You will be monitored for any adverse reactions to the surgery or anesthesia.
How Long Will It Take?
About 3-4 hours
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
The usual length of stay is 5-7 days. The length will depend on your overall health and the speed of your recovery. Your doctor may choose to keep you longer if complications arise.
At the Hospital
You will need to spend 1-2 days in bed after your operation.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
There are also steps you can take to reduce your chances of infection such as:
Recovery can take up to 6 weeks. Expect to see dramatic improvement in your overall ability to walk or exercise. When you return home, you will need to keep the wound clean to prevent infection. Pain can be managed with medications. You may be referred to a physical therapist to maintain or rebuild strength.
Call Your Doctor
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
If you think you have an emergency, call for emergency medical services right away.
American Heart Association
Society for Vascular Surgery
Heart and Stroke Foundation of Canada
ICES—Institute for Clinical Evaluative Sciences
Aortofemoral bypass surgery. UCSF Department of Surgery website. Available at: https://vascular.surgery.ucsf.edu/conditions--procedures/aortofemoral-bypass-surgery.aspx. Accessed November 30, 2017.
Peripheral vascular bypass surgery. Encyclopedia of Surgery website. Available at:
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Accessed November 30, 2017.
Surgical bypass for aortoiliac occlusive disease. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/surgical-bypass-aortoiliac-occlusive-disease. Accessed November 30, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 12/20/2014
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