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Peripheral artery bypass - leg

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

Peripheral artery bypass is surgery to reroute the blood supply around a blocked artery in one of your legs. Fatty deposits can build up inside the arteries and block them.

A graft is used to replace or bypass the blocked part of the artery. The graft may be a plastic tube, or it may be a blood vessel (vein) taken from your body (most often the opposite leg) during the same surgery.

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Description

Peripheral artery bypass surgery can be done in one or more of the following blood vessels:

During bypass surgery of any artery:

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

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

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:

Before having surgery, your doctor will do special tests to see the extent of the blockage.

Risks

Risks for any anesthesia and surgery are:

Risks for this surgery are:

Before the Procedure

You will have a physical exam and many medical tests.

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

During the 2 weeks before your surgery:

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

On the day of your surgery:

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.

When your provider says it is OK, 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 pulse will be checked regularly after your surgery. The strength of your pulse will show how well your new bypass graft is working. While you are in the hospital, tell your provider 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.

If you have blockages in many arteries, your symptoms may not improve as much. The prognosis is better if other medical conditions such as diabetes are well controlled. If you smoke, it is very important to quit. 

Related Information

Peripheral artery disease - legs
Angioplasty and stent placement - peripheral arteries
Aspirin and heart disease
Cholesterol and lifestyle
Antiplatelet drugs - P2Y12 inhibitors
Controlling your high blood pressure
Angioplasty and stent placement - peripheral arteries - discharge
Peripheral artery bypass - leg - discharge
Cholesterol - drug treatment

References

Bonaca MP, Creager MA. Peripheral artery diseases. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 64.

Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

Society for Vascular Surgery Lower Extremity Guidelines Writing Group; Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2S-41S. PMID: 25638515 www.ncbi.nlm.nih.gov/pubmed/25638515.

Writing Committee Members, Gerhard-Herman MD, Gornik HL, et al. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017;22(3):NP1-NP43. PMID: 28494710 www.ncbi.nlm.nih.gov/pubmed/28494710.

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Review Date: 1/31/2019  

Reviewed By: Mary C. Mancini, MD, PhD, Director, Cardiothoracic Surgery, Christus Highland Medical Center, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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