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Aortoiliac and Aortofemoral Bypass Graft Surgery


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.

Aortofemoral Bypass Graft
Aorta Femoral Bypass

Artificial grafts create a path so that blood can move around the blockage.

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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:

  • Pain that increases the longer you walk or exercise (called intermittent claudication)
  • Cold feet or legs
  • Scaly, dry, reddened, itchy, or brown skin on the legs or feet
  • Nonhealing and/or infected sores (ulcers) on your legs or feet
  • Gangrene
  • The need for amputation of the leg
  • Nerve damage

This surgery can restore blood flow to the legs.

Possible Complications

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

  • Infection
  • Obstruction of the new graft by blood clots
  • Bleeding
  • Complications from anesthesia
  • Scarring
  • Nerve damage

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:

  • Physical exam
  • Blood tests
  • Ankle-brachial index—This test compares the blood pressure measurements in your arms and legs. These numbers should be very similar. If the numbers for your legs are much lower than those for your arms, this suggests a blockage in the arteries that carry blood through your legs.
  • Doppler ultrasound —This test uses sound waves to examine the blood flow in your arteries. It can determine which arteries are blocked.
  • Angiography —Dye is injected into your arteries and x-ray pictures of your legs are taken. Because the dye will not be able to flow through areas narrowed or blocked by plaque, the specific location of blockages will be identified. Other types of minimally invasive angiography currently used also include CT angiography and MR angiography.

Leading up to your procedure:

  • Do not eat or drink anything after midnight the night before your surgery.
  • Arrange for help at home after you return from the hospital.
  • Arrange to have someone drive you home when you leave the hospital.

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 Procedure

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.

Post-procedure Care

At the Hospital

You will need to spend 1-2 days in bed after your operation.

  • You will be monitored carefully in the intensive care unit (ICU). You may be there for 1-2 days as needed.
  • An incentive spirometer, will be used every couple of hours during the day. This will keep your lungs as open as possible and help to avoid pneumonia.
  • A nasogastric (NG) tube may be placed during the operation. The tube is placed into your nose and down to your stomach. Your intestines often stop functioning normally after the surgery. You will not be able to eat anything by mouth until they begin to function again. The NG tube will then be removed. You will slowly progress from a liquid diet, to a soft foods diet, and finally to a regular diet.
  • You may also be given daily medications to help avoid blood clots.

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

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:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea or vomiting
  • Pain that you cannot control with the medications you were given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Cough, shortness of breath, or chest pain
  • Your leg becomes cold, pale, blue, tingly, or numb
  • Pain or swelling in your legs, calves, or feet

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: Accessed November 30, 2017.

Peripheral vascular bypass surgery. Encyclopedia of Surgery website. Available at: Accessed November 30, 2017.

Surgical bypass for aortoiliac occlusive disease. Society for Vascular Surgery website. Available at: Accessed November 30, 2017.

Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 12/20/2014