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    Femoral-Tibial Bypass Surgery for Peripheral Arterial Disease

    Femoral-Tibial Bypass Surgery for Peripheral Arterial Disease

    Surgery Overview

    Femoral-tibial bypass surgery (also known as infra-popliteal reconstruction) is used to bypass diseased blood vessels in the lower leg or foot.

    To bypass the narrowed or blocked blood vessel, blood is redirected through a healthy blood vessel that has been transplanted or through a man-made graft material. This vessel or graft is sewn above and below the diseased artery so that blood flows through the new vessel or graft. Before surgery, the doctor determines what type of material is best suited to bypass the blood vessel.

    Whenever possible, the surgeon will choose to use an existing piece of vein taken from either leg. Man-made graft materials (such as polytetrafluoroethylene [PTFE] or Dacron) are more likely to become narrowed again. But they may still be effective and are used when a vein is not available.

    The section of vein or man-made blood vessel is sewn onto the small vessels of the lower leg or foot so that blood can travel through the new graft vessel and around the diseased area.

    General anesthesia or an injection in the spine (epidural) is used for this surgery. General anesthesia will cause you to sleep through the procedure. An epidural prevents pain in the lower part of the body.

    What To Expect After Surgery

    You may need to stay in bed for 1 to 2 days after surgery. You may need to stay in the hospital for 3 to 5 days.

    You will have some pain from the cuts (incisions) the doctor made. The pain usually gets better after about 1 week. Your doctor will give you pain medicine. You can expect your leg to be swollen at first. This is a normal part of recovery and may last 2 or 3 months.

    You will need to take it easy for 2 to 6 weeks at home. It may take 6 to 12 weeks to fully recover. You will probably need to take at least 2 to 6 weeks off from work. It depends on the type of work you do and how you feel.

    You will need to have regular checkups with your doctor to make sure the graft is working.

    Why It Is Done

    This surgery is used for people who have narrowed or blocked tibial or peroneal arteries, which are near the surface of the legs. Most of the time, people also have blocked femoral and popliteal arteries too. Usually, the blockage must be causing severe symptoms or be limb-threatening before bypass surgery is considered.

    How Well It Works

    Bypass surgery can restore blood flow and relieve intermittent claudication . 1

    Risks

    All surgeries carry a certain amount of risk. These risks include:

    • Infection from the incision.
    • Bleeding.
    • Heart attack or stroke.

    Specific risks for this bypass surgery include:

    • Leg swelling.
    • Failed or blocked grafts.

    What To Think About

    Your doctor may recommend that you try an exercise program and medicine before he or she recommends that you have this surgery.

    Click here to view a Decision Point. Peripheral Arterial Disease: Should I Have Surgery?

    Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

    References

    Citations

    1. Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11): e463?e654.

    Credits

    By Healthwise Staff
    Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
    David A. Szalay, MD - Vascular Surgery
    Last Revised October 26, 2013

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