Femoropopliteal Bypass

WHAT YOU SHOULD KNOW:

Femoropopliteal bypass is surgery to place a graft to bypass narrowed arteries in your upper leg. The graft may be from a blood vessel in your arm or leg, or it may be man-made. A femoropopliteal bypass can improve blood flow to your leg and foot, and decrease your symptoms.

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 bleed more than expected or get an infection after surgery. Your kidneys may not work properly. You may continue to have long-term pain and swelling in the treated leg. Your new graft may narrow, become blocked, or get infected. You may need another surgery. Graft failure may increase your risk of needing your leg or foot amputated (cut off). You may get a blood clot that travels to your heart, lungs, or brain and causes life-threatening problems, such as a heart attack or stroke.
  
  
• If you do not have surgery, symptoms such as pain may get worse, or begin to happen 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 life-threatening problems, such as a stroke or heart attack.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent 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.
  
  
• 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 EKG. This test records the electrical activity of your heart. It is used to check for changes in how your heart beats.
  
  
• 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 before your surgery to make you sleepy. You will be taken to an operating room. 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 will make an incision in your groin near your femoral artery. Another incision will be made above or below your knee near your popliteal artery. Your caregiver will make a tunnel between the 2 incisions, 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, an incision 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 or man-made graft will be placed in the tunnel space. One end of the graft will be sewn to the femoral artery, above the blockage. The other end will be sewn to the popliteal artery, below the blockage. Blood will then flow through the graft around the blocked area. Your incisions will be closed with stitches or staples.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Caregivers will watch your closely, and may check your wound. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are okay, you will be taken to your hospital room.

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 medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.
  
  
• Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.

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 opens the airways going to your lungs and helps prevent a lung infection after surgery. Coughing helps bring up mucus from your lungs for you to spit out. You should breathe deeply and cough every hour while you are awake.

• Take 10 deep breaths in a row every hour while you are awake. 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. Hold a pillow tightly against your wound when you cough to help decrease the pain.
  
  
• 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. Do this 10 times in a row every hour while you are awake. When you are asleep, caregivers may wake you up every 2 to 4 hours to use your spirometer.