Description

Peripheral artery bypass surgery can be done in one or more of these arteries to treat a blockage:

• Aorta -- the main artery that comes from your heart
• Iliac artery -- in your hip
• Femoral artery -- in your thigh
• Popliteal artery -- behind your knee
• Tibial and peroneal artery -- in your lower leg
• Axillary artery -- in your armpit

During bypass surgery of any artery:

• You will receive medicine (anesthesia) so that you do not feel pain. The kind of anesthesia you receive will depend on what artery is being treated.
• Your surgeon will make a cut over the blocked area of the artery. The surgeon will then move skin, muscle, and other tissue out of the way.
• Your surgeon will place clamps on the artery at each end of the blocked section. The surgeon will then use a graft to replace or bypass the blocked part of your artery. The graft may be a plastic tube, or it may be a blood vessel taken from your body (usually the opposite leg) during the same surgery.
• After the graft is sewn in place, your surgeon will make sure the blood flow to your lower leg is good. Then your cut will be closed. Your surgeon may do an x-ray called an arteriogram to make sure that the graft is working.

If you are having aortoiliac (to treat your aorta and iliac artery) or aortobifemoral (to treat your aorta and both femoral arteries) bypass surgery:

• You will probably have general anesthesia. This will make you unconscious and unable to feel pain. Or you may have epidural or spinal anesthesia. The doctor will inject your spine with medicine to make you numb from your waist down.
• Your surgeon will make a surgical cut in the middle of the abdoman to reach the aorta and iliac arteries.

If you are having femoral popliteal bypass surgery (to treat your lower leg):

• You may have general anesthesia. You will be unconscious and unable to feel pain. You may instead have an epidural or spinal anesthesia. The doctor will inject your spine with medicine to make you numb from your waist down. Some people have local anesthesia and a medicine to relax them. Local anesthesia numbs just the area being worked on.
• Your surgeon will make a cut in your leg between your groin and knee. It will be near the blockage in your artery.

Why the Procedure is Performed

Symptoms of a blocked peripheral artery are pain, achiness, or heaviness in your leg that starts or gets worse when you walk.

You may not need bypass surgery if these problems happen only when you walk and then go away when you rest. You may not need this surgery if you can still do most of your everyday activities. Your doctor can try medicines and other treatments first.

Reasons for having arterial bypass surgery of the leg are:

• Your symptoms keep you from doing your everyday tasks.
• Your symptoms do not get better with other treatment.
• You have skin ulcers (sores) or wounds on your leg that do not heal.
• You have an infection or gangrene in your leg.
• You have pain in your leg from your narrowed arteries even when you are resting or at night.

Before surgery is considered, the doctor will order special tests to show that you have a severe blockage in your blood vessels.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery are:

• Bypass does not work
• Damage to a nerve that causes pain or numbness in your leg
• Damage to nearby organs in the body
• Damage to the bowel during aortic surgery
• Excess bleeding
• Infection in the surgical cut
• Injury to nearby nerves
• Sexual problems caused by damage to a nerve during aortofemoral or aortoiliac bypass surgery
• Surgical cut opens up
• You need to have a second bypass surgery or a leg amputation

Before the Procedure

Your doctor will do a thorough physical exam and several medical tests.

• Most people who have a peripheral artery bypass first need to get their heart and lungs checked.
• If you have diabetes, you will need to be seen by the doctor who takes care of your diabetes.

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other similar drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, you need to stop. Ask your doctor or nurse for help.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

Do NOT drink anything after midnight the night before your surgery, including water.

On the day of your surgery:

• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Right after surgery, you will go to the recovery room, where nurses will watch you closely. After that you will go either to the intensive care unit (ICU) or a regular hospital room.

• After aortoiliac or aortofemoral bypass, you may need to spend 1 or 2 days in bed. You will probably be in the hospital for 4 to 7 days.
• After femoral popliteal bypass, you will spend less time or no time in the ICU.

When your doctor says it is okay, you will be allowed to get out of bed. You will slowly increase how far you can walk. When you are sitting in a chair, keep your legs raised on a stool or another chair.

Your doctor and nurse will check your pulses regularly after your surgery. Your pulse rate will show whether your new bypass graft is working well. While you are in the hospital, tell your nurse or doctor right away if the leg that had surgery feels cool, looks pale or pink, feels numb, or if you have any other new symptoms.

You will receive pain medicine if you need it.

Outlook (Prognosis)

Bypass surgery improves blood flow in the arteries for most people. You may not have symptoms anymore, even when you walk. If you still have symptoms, you should be able to walk much farther before they start.

Your results will depend on where your blockage was, the size of the blood vessel, and whether you have a blockage in your other arteries.

Alternative Names

Aortobifemoral bypass; Femoropopliteal; Femoral popliteal; Aorta-bifemoral bypass; Axillo-bifemoral bypass; Ilio-bifemoral bypass; Femoral-femoral bypass; Distal leg bypass

References

Creager MA and Libby P. Peripheral arterial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 57.

Eisenhauer AC, White CJ. Endovascular treatment of noncoronary obstructive vascular disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 59.

Update Date: 1/25/2012

Reviewed by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.