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.

Getting Ready

Before your surgery:

• Ask a family member or friend to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Your caregiver may give you aspirin or other blood-thinning medicines before your surgery. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
  
  
• If you smoke, stop smoking. Smoking harms the heart, lungs, and the blood. Smoking increases the risk for your new graft to become blocked, and your bypass surgery to fail. You are more likely to have a heart attack, lung disease, and cancer if you smoke. Ask your caregiver how to stop smoking if you are having trouble quitting.
  
  
• You may need blood tests before your surgery. A magnetic resonance (MR) or computed tomography (CT) angiogram may be done to look at your legs, and blood vessels. An arteriography, ankle-brachial index test, or a Doppler study may also be done to check the blood flow in your legs. If you are having symptoms of heart problems, you may need a stress test or electrocardiogram. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of all the medicines you take, or your pill bottles with you to the hospital.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You are taken to the room where your surgery will be done. You may receive general anesthesia to keep you asleep, or regional anesthesia to numb you below your waist. An incision (cut) is made 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 will be 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, 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 flow through the graft and around the blocked area. Your incisions will be 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 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• You get sick (cold or flu) or have a fever (high body temperature).
  
  
• You have new pain, or your leg or foot pain suddenly gets worse.
  
  
• You have new ulcers on your legs or feet.

Seek Care Immediately if

• You have bleeding, such as a nosebleed that does not stop.
  
  
• You have numbness (loss of feeling), tingling, or weakness in your leg, foot, or toes.
  
  
• Your foot or toes suddenly become cold, darker in color, or pale (loss of color).
  
  
• You have new leg pain, or leg pain that is getting worse with movement or when resting.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing

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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 (Precare)