Femoropopliteal Bypass Surgery

(Leg Artery Bypass Surgery)

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

A surgical procedure where a vein from the patient's body or an artificial vein is used to construct a bypass around a blocked main leg artery.

Parts of the Body Involved

Leg, groin

Reasons for Procedure

• To restore proper blood supply to the lower leg
• To relieve leg pain caused by a blocked artery
• To prevent amputation of the lower leg due to insufficient blood supply

Risk Factors for Complications during the Procedure

• Stress
• Obesity
• Smoking
• Diabetes
• High blood pressure
• Hyperlipoproteinemia
• Chronic or recent illness
• Excessive use of alcohol
• Smoking
• Use of narcotics or other mind altering drugs
• Use of certain prescription medications, including muscle relaxants and sedatives, blood pressure medications, insulin, beta-adrenergic blockers, cortisone

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Electrocardiogram (ECG, EKG) - a test that records the heart's activity by measuring electrical currents through the heart muscle
• Chest x-rays
• Blood tests

In the days leading up to your procedure:

• Arrange for a ride to and from the hospital
• Arrange for help at home after returning from the hospital
• Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs for one week before procedure
• You may be given antibiotics to take before the procedure to help prevent infection
• The night before, have a light dinner and do not eat or drink anything after midnight

During Procedure:

• Anesthesia
• Catheters to monitor the blood pressure in your veins and arteries, as well as your urinary output
• IV heparin (a drug to help prevent blood clots)

Anesthesia - In most cases, general anesthesia by injection and inhalation. In some cases, spinal anesthesia by injection.

Description of the Procedure

The surgeon makes an incision in the thigh along the portion of the saphenous vein to be removed for use as the bypass graft. (The saphenous vein runs the full length of the thigh.) The vein is dissected and removed. (If the vein is unsuitable to be used as a graft, an artificial, tubular prosthetic graft is used instead.) Once the vein is removed, the small branches of the vein are tied off.

Next, an incision is made in the groin to expose the femoral artery. Another incision is made near the inside of the back of the knee to expose the popliteal artery.

The femoral artery and the popliteal artery are then isolated and clamped (with vascular clamps) to block the flow of blood while the graft is being attached. The piece of the saphenous vein that is now the graft is tunneled along the femoral artery from the groin to the knee. One end of this vein graft is stitched into the femoral artery at the groin, and the other end of the vein graft is stitched into the popliteal artery at the knee. (Because the vein has small valves inside of it that prevent the back flow of blood, the saphenous vein must be reversed before being tunneled and attached to the arteries.)

Once the graft is attached, blood is passed through the vein graft to check for any leaks, which, if found, are repaired. The vascular clamps are then removed, allowing blood to flow through the graft to the lower leg. The incisions are closed with stitches.

In some cases, rather than being removed, reversed, and tunneled, the saphenous vein is used as a graft while left in place. This is called in situ. In this procedure, the valves inside the vein are removed with a small scope and a small cutting instrument known as a valvulotome. The vein is then, while still in situ, attached to the femoral and popliteal arteries to form a graft.

After Procedure:

• Fluids, pain medications, and anticoagulants are given by IV for the first 24-48 hours, then by mouth
• In some cases, you may wear an oxygen mask for 10-12 hours following surgery
• An epidural in your back to numb the surgical site and relieve pain will be left in place for 3-5 days after surgery; once this is removed, medication to relieve pain is given by mouth

How Long Will It Take? 1-3 hours

Will It Hurt? Anesthesia prevents pain during surgery. After the surgery, though, there is some pain that can continue for weeks (or, in some cases, months) as leg swelling subsides and your leg heals. Your doctor will prescribe pain medications to help manage your pain and discomfort, both while you are in the hospital and when you go home.

Possible Complications:

• Excessive bleeding
• Heart attack, heart failure, or death during or after the procedure (3-5% risk factor)
• Blood clots
• Clotting that causes blockage of bypass graft
• Kidney failure
• Surgical wound infection
• Limb amputation

Average Hospital Stay: 7-10 days

Postoperative Care:

• Use cold packs to decrease pain and swelling during the first 1-2 days after surgery. Use them for 15-20 minutes per hour, as needed. After 48 hours, you may use a heating pad or hot water bottle for 15-20 minutes per hour.
• Stay in bed for 1-2 days after surgery. By the third or fourth day, you will be able to do minimal walking, with assistance of a nurse, or a walker.
• Surgical wounds should be healed and stitches removed by the time you are released from the hospital.
• It is normal for your leg to remain swollen for 2-3 months.
• Do not drive for 4-6 weeks, or, if pain lasts longer then that, until you are pain free.
• To strengthen your leg, walk each day (as directed by your doctor), increasing the length of your walk slowly, each day, over time.
• Your doctor will prescribe physical therapy as well as other exercises to help heal and strengthen your leg.
• Increase the amount of walking and of overall physical activity slowly each day.
• When you are not walking or doing exercises, keep your legs elevated, especially the leg on which surgery was performed.
• Place a pillow under your leg when sleeping.
• Shower as normal, using mild soap and water, but do not take baths until the surgical wound heals completely.
• When not showering, keep the surgical wound as dry as possible, but do not use talc or powder.
• You will take anticoagulant medication for several months following surgery. If the medication given is Coumadin, talk to your doctor or a registered dietitian about your diet, because this medication interacts with vitamin K.
• Avoid fatty foods.
• Do not smoke; smoking can jeopardize the success of your surgery.
• You'll have a follow-up visit with your surgeon four weeks after surgery, and then every three months thereafter for the next year.

Outcome

• Full healing of surgical wound
• Re-establishment of proper blood flow to the lower leg
• Return to normal activities without leg pain

Call Your Doctor If Any of the Following Occurs

• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
• Severe pain in the leg
• Your leg becomes cold, pale, blue, tingly, or numb
• Signs of infection, including fever and chills
• Nausea or constipation
• New, unexplained symptoms
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
• Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain

SOURCES:

Alexander's Care of the Patient in Surgery, 11th ed. Mosby, 1999.

Mosby's Perioperative Nursing Series: Vascular Surgery. Mosby, 1998.

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Last reviewed April 2001 by Medical Review Board