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.

Getting Ready

Before your surgery:

• Arrange a ride home. Ask a family member or friend to drive you home after your surgery or procedure. 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 prevent your gums from bleeding.
  
  
• Do not smoke. Smoking increases the risk that your new graft will become blocked and your bypass surgery will fail. If you smoke, it is never too late to quit. Ask your caregiver for information if you need help 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 Doppler study may be done to check the blood flow in your legs. If you have 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.
  
  
• Write down the correct date, time, and location of your surgery.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Ask your caregiver before taking any medicine on the day of your procedure. 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 may receive general anesthesia to keep you asleep, or regional anesthesia to numb you below your waist. An incision will be made 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 will be 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 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 and 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.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• You get sick or have a fever.
  
  
• 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, tingling, or weakness in your leg, foot, or toes.
  
  
• Your foot or toes suddenly become cold, darker in color, or pale.
  
  
• You have new leg pain, or leg pain that worsens with movement or when resting.
  
  
• You have weakness in an arm or leg.
  
  
• You become confused or have difficulty speaking.
  
  
• You have dizziness, a severe headache, or vision loss.
  
  
• You have discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain. It lasts for more than a few minutes or keeps returning.
  
  
• You have discomfort or pain in your back, neck, jaw, stomach, or arm.