Femoropopliteal Bypass Surgery Overview

In this surgery, the patient's 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 © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will likely do the following:

• Blood tests
• Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
• Chest x-ray —a test that uses radiation to take pictures of structures inside the body
• Ultrasound—using radio-waves to find the narrowing of the artery

Leading up to the surgery:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
• 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 (almost always used)—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

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

• For the first 24-48 hours, fluids and pain medicines may be given by IV.

• You may need to wear 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. Once this is removed, your doctor will give you pain medicine.

How Long Will It Take?

1-3 hours

How Much Will It Hurt?

As you heal and the swelling in your leg subsides, you may have pain for weeks or even months. Ask your doctor about medicine to help with the pain. Keep in mind that it is normal for your leg to remain swollen for 2-3 months.

Average Hospital Stay

7-10 days

Post-procedure Care

At the Hospital

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

• For the first 1-2 days, use cold packs to decrease pain and swelling. A nurse will apply a cold pack to the area for 15-20 minutes each time.
• You may wear boots or special socks to help prevent blood clots
• You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
• Your incision will be examined often for signs of infection.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Do not drive for 4-6 weeks, or until you are pain free.
• If advised by your doctor, walk every day. Walking will make your legs stronger. Slowly increase how far you walk.
• Work with a physical therapist.
• Slowly increase the activity you do each day.
• When sitting, keep your legs elevated.
• Place a pillow under your leg when sleeping.
• Shower as normal, using mild soap and water. Do not take baths until the wound has healed.
• Keep the wound dry. Avoid using talc or powder.
• Avoid fatty foods.
• Do not smoke. Smoking can interfere with healing.
• Be sure to follow your doctor’s instructions .

RESOURCES:

American Heart Association
http://www.americanheart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

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

References:

MacVittie B. Mosby's Perioperative Nursing Series: Vascular Surgery. St. Louis, MO: Mosby; 1998.

Rothrock JC, Smith DA, McEwen DR. Alexander's Care of the Patient in Surgery. 11th ed. St. Louis, MO: Mosby; 1999.