Femoropopliteal Bypass Surgery (Leg Artery Bypass Surgery)

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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. Blocked arteries in the extremities are referred to as peripheral arterial disease .

Femoropopliteal Bypass Graft

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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 Developing Peripheral Arterial Disease

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-ray a test that uses radiation to take pictures of structures inside the body
  • 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.
  • For up to a week before your procedure, do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (for one week before procedure). Confirm this with your physician.
  • You may be given antibiotics to take before the procedure to help prevent infection.
  • The night before your procedure, have a light dinner and do not eat or drink anything after midnight.

During Procedure

You will be given:

AnesthesiaCatheters to monitor the blood pressure in your veins and arteries, as well as your urinary output Anesthesia In most cases, general anesthesia by injection and inhalation is given. In some cases, spinal anesthesia by injection is given. Description of the ProcedureThe 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 and pain medications may be 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) may 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 ComplicationsExcessive bleedingHeart attack , heart failure , or death during or after the procedure (3%-5% risk factor) Blood clotsClotting that causes blockage of bypass graftKidney failureSurgical wound infectionLimb amputation Average Hospital Stay7-10 days Postoperative Care At the HospitalUse 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. At Home After discharge 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, 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.Avoid fatty foods.Do not smoke; smoking can jeopardize the success of your surgery. Call Your Doctor If Any of the Following OccursRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision sitesSevere pain in the legYour leg becomes cold, pale, blue, tingly, or numbSigns of infection, including fever and chills Nausea or constipationNew, unexplained symptomsCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency, frequency of urination, or persistent bleeding in the urinePain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain RESOURCES:
American Heart Associationhttp://www.americanheart.org National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov CANADIAN RESOURCES: Health Canadahttp://www.hc-sc.gc.ca/index_e.html Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/Page.asp?PageID=24 References: Alexander's Care of the Patient in Surgery . 11th ed. Mosby; 1999. Mosby's Perioperative Nursing Series: Vascular Surgery . Mosby; 1998. Last reviewed November 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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