Lower Extremity Bypass

Why would you need a new artery placed in your leg?

Bypass surgery in necessary when a patient develops problems related to circulatory compromise in the lower leg.

Specifically, the three reasons to consider a bypass operation would be:

1. So much difficulty walking that you cannot work or your quality of life is minimal
2. Severe pain in your feet that you cannot sleep or always have to sit down with your legs dependent
3. Sores on the legs or feet that will not heal

A bypass is typically considered after other conservative measures have failed to manage he problem- medication, exercise and smoking cessation.

What does a bypass procedure do?

With the help of a natural or synthetic graft, a surgical bypass routes blood flow around an area of blockage caused by peripheral arterial disease (PAD).  The surgery does not cure the disease or remove the blockage. Think of a surgical bypass as a road detour.

How long does the procedure last?

The lifespan of a surgical bypass depends on the health of your arteries, the type of graft used (natural vein grafts last longer than synthetic ones) and other health factors, such as whether you smoke, or have diabetes or kidney failure.

How is it done?

You will be given a general or spinal anesthetic so that you will feel no pain during the operation.  

A fem-pop bypass (groin area to knee area), the most common type, uses a natural or synthetic graft to create the detour around the blockage beginning at your groin/thigh crease and ending at the inner knee, or sometimes the calf or foot.

An incision, about 4 inches long, is made at the groin crease and again at the end point on the inner aspect of the thigh (close to the knee).  

If your own vein is used to create the graft, other small incisions may be made on the inner portion of the thigh. Otherwise, a synthetic tube made of fabric (Dacron) or plastic (PTFE, Gortex) will be used.  

The graft is sewn to the artery at both ends with fine stitches.  

Surgery can take 1.5 to 6 hours. 

Risks of bypass surgery

The bypass graft can become blocked soon after surgery or years later. This is sometimes remedied by another surgery or catheter procedure, sometimes by a new bypass.  This problem is worsened if you continue to smoke after the surgery

Other possible complications soon after surgery include: 

• Heart attack, as many patients with PAD also have heart disease. 
• Wound infections, though antibiotics are given before and after surgery to help prevent this. 
• Bladder or other infections. 
• Pneumonia.

Preparing for a bypass

When you agree to surgery...

• If you smoke, stop as soon as possible to lessen the chance of many of the complications.
• If you have a heart doctor (cardiologist), your vascular surgeon may want you to get her/his okay.
• You may need blood tests, an EKG, special x-rays or a heart stress test.

Days before...

• Follow your normal routine and get plenty of sleep.
• Carefully follow instructions about medications the day before and day of surgery