Femoro-popliteal Bypass is required in some patients with symptomatic peripheral vascular disease

A blockage in the superficial femoral artery and /or popliteal artery cannot always be treated with an endovascular procedure.

This procedure is performed on patients experiencing muscle pain on walking (claudication) short distances, which is having a major impact on quality of life. In more severe cases, this procedure may be required for pain at rest (referred to as rest pain) or non-healing leg ulceration or tissue loss.

Pre-operative preparation

In order to prepare for Femoro-popliteal Bypass, it is vital that a full medical assessment be obtained to confirm fitness for anaesthesia.

This will involve a number of blood tests, and an assessment of the heart with an ECG, thallium scan, and referral to a cardiologist if there are any concerns about your heart.

As the best choice of conduit for the bypass is the patient’s own saphenous vein, the leg is scanned using ultrasound to confirm the vein’s suitability. If there is no suitable vein, a prosthetic (artificial) graft can be used.

Day of procedure

You may be admitted on the morning of the procedure if your assessment has been completed. You will be required to bring ALL of your usual medications.

 It is important to fast for at least 6 hours prior to the procedure. For a morning procedure, you will need to fast from midnight, whereas for an afternoon procedure, this will mean fasting from 7am.

Your anaesthetist will consult you prior to the operation and explain the anaesthetic and its risks to you.

The procedure

A full general anaesthetic is administered, and a tube inserted into your windpipe (trachea) to help with your breathing while you are asleep. A catheter is also inserted into your bladder to monitor your urine output. This will remain for the first 48 hours.

The operation is performed on the affected leg.

If the saphenous vein is suitable, it is removed through an incision extending from just below the knee to the groin. The femoral artery is exposed in the groin and the popliteal artery is exposed either above or below the knee, depending on which site is the more appropriate.

Heparin is administered to help keep the blood thin. The graft (vein or prosthetic) is joined (anastomosed) to the femoral artery and popliteal artery, thereby bypassing the blockage. This restores the circulation to the lower part of the leg.

The wounds are closed and dressed, with suction drains placed adjacent to both joins. Antibiotics are commenced at the time of surgery and are continued for 48 hours until all lines and catheters are removed.

Post-operative course

All patients are monitored closely for the first 24 hours. This can be conducted on the ward or the intensive care unit.

Patients are then transferred to the ward, where oral fluids and diet are slowly re-introduced, and mobilisation commenced. It is a gradual process, but most patients are fit for discharge after 5 to 7 days.

Following Discharge

You are encouraged to be active within your comfort zone. You will be given an appointment for review in two weeks and then you will be followed at regular intervals to monitor the graft

If you encounter any discomfort or wound problems, contact the rooms immediately.