Femoropopliteal Bypass

WHAT YOU SHOULD KNOW:

• Femoropopliteal bypass surgery is done when the blood flow to your leg is decreased or blocked. The femoral artery is the main blood vessel in your thigh. Blood flows from the femoral artery into the popliteal artery, which is behind your knee. These arteries carry blood and oxygen to your legs. When your femoral artery is narrowed or blocked, you have less blood flowing to your leg. This is often caused by a disease called atherosclerosis. Atherosclerosis happens when fat or cholesterol (plaque) builds up on the insides of your artery walls.
  
  
• A blocked femoral artery may cause pain when you move your leg, or when you are at rest. You may develop ulcers (sores) on your foot that do not heal. The skin on your toes or foot may turn very dark or black. During femoropopliteal bypass, a graft is used to create a new blood flow pathway to your leg. A graft is a tube used to replace your blood vessel. Your graft may be a healthy blood vessel from your leg or arm, or a man-made graft. Femoropopliteal bypass can improve the blood flow to your leg and foot, and lower your risk for ulcers. Femoropopliteal bypass may also decrease your symptoms, such as leg pain making it easier to do your daily activities.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the medicines used during, and after your surgery. During surgery, you may bleed more than expected. After surgery, you may have pain, and your kidneys may not work properly. You may get an infection in your wound, or you may have increased bleeding from your wound. You may have long-term pain and swelling in the treated leg. Your new graft may narrow, become blocked, and get infected. The blood flow to your leg and foot may decrease again, and you may need another surgery. Graft failure may increase your risk of needing your leg or foot amputated (cut off). After surgery, you may get a blood clot that can travel to your lungs and cause trouble breathing. You may have a stroke or a heart attack, and you may die.
  
  
• If you do not have surgery, parts of your leg or foot may not get enough blood and oxygen. Your pain may get worse, or you may have pain at rest. Over time, you may not be able to walk as well, or as far as you were once able to. You may get sores on your foot that do not heal, or the skin tissue may die. If the sores or dead skin become infected, you may need to have part of your leg or foot amputated. Without surgery, your risk is greater for having a stroke or heart attack, and you may die. Talk to your caregiver if you have questions or concerns about your surgery or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
  
  
• Heart monitor: A heart monitor is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-like screen. This shows caregivers a tracing of the electrical activity of your heart. The heart monitor helps caregivers see problems with the way your heart is beating. You will have a heart monitor on during and after your surgery.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Medicines:
  
  
  • Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
    
    
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Pre-op care: You may be given medicine right before your surgery to make you feel relaxed and sleepy. You are taken on a stretcher to the surgery room, and moved to an operating table. You will lie on your back with your leg to be operated on slightly bent at the knee. Cushions may be placed under your knee to support your leg.
  
  
• Anesthesia: You are given medicine called anesthesia to make you comfortable during your surgery. Caregivers work with you to decide which anesthesia is best for you. You will have one of the following:
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Regional anesthesia: This is medicine put into an IV in your leg. A pressure cuff is first put on your leg. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in your leg so you will not have pain.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

During your surgery:

• Your caregiver makes an incision (cut) in your groin near your femoral artery. The groin is the area between your stomach and the top of your leg. Another cut is made above or below your knee near your popliteal artery. Your caregiver makes a tunnel between the two cuts, under your skin and muscles. The tunnel is the area where the graft will be placed.
  
  
• If your own vein is used as the graft, a cut will be made in your lower leg or arm. A vein from your lower leg or arm will be removed. The vein graft may be flushed with blood thinning medicine. The vein graft, or a man-made graft is placed in the tunnel space. One end of the graft is sewn to the femoral artery, above the blockage. The other end is sewn to the popliteal artery, below the blockage. Blood will then be able to flow through the graft around the blocked area. Your incisions are closed with stitches or staples.

After your surgery:

You are taken to a room where you can rest until you are fully awake. Caregivers will watch you closely for any problems. A caregiver may check your wound (surgery site) shortly after your surgery. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are not having any problems, you will be taken to your hospital room.

• Vital signs: Caregivers will take your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths).
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. You may need to have blood taken more than once.

Medicines:

You may be given the following medicines:

• Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
  
  
• Pain medicines: Your caregiver may give you medicine to decrease your pain. Tell your caregiver if your pain does not get better after taking your medicine. Do not wait until the pain is very bad to ask for your pain medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Your caregiver may also give you the following:
  
  
  • Patient controlled analgesia: You may get pain medicine from a special pump. You can receive the pain medicine through an IV or an epidural line. This is called patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). Your caregivers set up the PCA pump to give you small amounts of pain medicine. The PCA pump has a cord coming from it, with a push button on the end. When you feel pain and push the button, you will give yourself pain medicine. To keep you from getting too much medicine, there is a limit on how often you can get the medicine. Do not let anyone else push the button for you. Your pump may give you a constant dose of pain medicine, as well as the medicine that you give yourself. If your pain is still bad even with using the PCA, let your caregivers know.
    
    

Activity:

Your caregiver may have you get out of bed to walk shortly after your surgery. Walking decreases your risk for blood clots and lung infections.

Deep breathing and coughing:

Deep breathing and coughing help keep you from getting a lung infection after surgery. Deep breathing opens the airways going to your lungs. Coughing helps bring up sputum (mucus) from your lungs for you to spit out. You should breathe deeply and cough every hour while you are awake.

• Hold a pillow tightly against your wound when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum you cough up into a tissue. Take 10 deep breaths in a row every hour while you are awake. Remember to follow each deep breath with a cough.
  
  
• You may need to use an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your spirometer every hour while you are awake. When you are asleep, caregivers may wake you up every 2 to 4 hours to use your spirometer.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Femoropopliteal Bypass (Inpatient Care)