Peripheral Bypass Surgery

What does "bypass surgery" mean?

Bypass surgery is a surgically constructed new route around an area of blockage or narrowing and can be performed on any artery in the body, but most often is performed on the femoral arteries in the groin, or the popliteal arteries behind the knee. During bypass surgery, a graft vein or artery is taken from a healthy blood vessel in the body (sometimes an artificial graft is used). The graft is then surgically attached above and below an obstructed or poorly functioning artery. After surgery, the blood will flow thru the graft vessel, avoid or "bypass" the blocked vessel, and provide oxygen and nutrients necessary for survival to the area of tissue beyond the blockage.

Why is the doctor performing this surgery?

To bypass, or go around, the obstruction caused by an artery filled with a clot or with plaque (atherosclerosis). In the groin and/or legs, decreased blood flow (therefore, decreased oxygen and nutrients) causes painful muscle cramping and spasms, known as claudication. Claudication can progress to constant pain, cold legs and feet, sores, and even gangrene. If the condition is not treated adequately with medications, exercise, and quitting smoking, surgery is necessary.

What is the surgery?

Two common vascular bypass surgeries performed include:

• Femoral-Popliteal Bypass - The femoral arteries in the groin, and the popliteal arteries behind the knees, can both be areas of atherosclerotic plaque build-up. A healthy graft vessel is taken from elsewhere in the body (often the saphenous vein in the leg) and is attached to the femoral artery above the narrowing. The other end is attached to the popliteal artery behind the knee below the narrowed area. The blood will then flow easily thru this new vessel, and avoid the plaque obstruction in the groin.
• Aorto-Bifemoral Bypass - If the plaque build-up is higher up in the femoral arteries or in the iliac arteries, a different surgical bypass is necessary. This bypass requires an artificial graft that is shaped like an upside-down Y. The top part is attached to the aorta, and the bottom two pieces are attached to the femoral or iliac arteries, beyond the plaque obstruction. The blood will then flow from the aorta, into the graft, branch into two graft conduits, then back into the patient's own femoral or iliac arteries, and continue down the arteries of the legs.

Where is the surgery performed?

In the Operating Room (OR), under general anesthesia.

How long does this surgery take?

Femoral-Popliteal Bypass and Aorto-Bifemoral Bypass each take 2-4 hours.