Femoral-Tibial Bypass Surgery for Peripheral Arterial Disease

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Surgery Overview

Femoral-tibial bypass surgery (also known as infra-popliteal reconstruction) is used to bypass diseased blood vessels in the lower leg or foot.

To bypass the narrowed or blocked blood vessel, blood is redirected through a healthy blood vessel that has been transplanted or through a man-made graft material. This vessel or graft is sewn above and below the diseased artery so that blood flows through the new vessel or graft. Before surgery, the doctor determines what type of material is best suited to bypass the blood vessel.

Whenever possible, the surgeon will choose to use an existing piece of vein taken from either leg. Man-made graft materials (such as polytetrafluoroethylene [PTFE] or Dacron) are more likely to become narrowed again. But they may still be effective and are used when a vein is not available.

The section of vein or man-made blood vessel is sewn onto the small vessels of the lower leg or foot so that blood can travel through the new graft vessel and around the diseased area.

General anesthesia or an injection in the spine (epidural) is used for this surgery. General anesthesia will cause you to sleep through the procedure. An epidural prevents pain in the lower part of the body.

What To Expect After Surgery

You may need to stay in the hospital for 3 to 5 days.

You will have some pain from the cuts (incisions) the doctor made. The pain usually gets better after about 1 week. Your doctor will give you pain medicine. You can expect your leg to be swollen at first. This is a normal part of recovery and may last 2 or 3 months.

You will need to take it easy for 2 to 6 weeks at home. It may take 6 to 12 weeks to fully recover. You will probably need to take at least 2 to 6 weeks off from work. It depends on the type of work you do and how you feel.

You will need to have regular checkups with your doctor to make sure the graft is working.

Why It Is Done

This surgery is used for people who have narrowed or blocked tibial or peroneal arteries, which are near the surface of the legs. Most of the time, people also have narrowed or blocked femoral and popliteal arteries too. Usually, a person has severe symptoms or the problem is limb-threatening before bypass surgery is considered.footnote 1, footnote 2

How Well It Works

Bypass surgery can restore blood flow and relieve intermittent claudication.footnote 1, footnote 2

Risks

All surgeries carry a certain amount of risk. These risks include:

  • Infection from the incision.
  • Bleeding.
  • Heart attack or stroke.

Specific risks for this bypass surgery include:

  • Leg swelling.
  • Failed or blocked grafts.

What To Think About

Your doctor may recommend that you try an exercise program and medicine before he or she recommends that you have this surgery.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.
  2. Conte MS, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S-41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.

Other Works Consulted

  • Conte MS, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S-41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.
  • Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.

Credits

ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerDavid A. Szalay, MD - Vascular Surgery

Current as ofOctober 5, 2017