Femoral Popliteal Bypass Surgery

What is femoral popliteal bypass surgery and percutaneous transluminal angioplasty (PTA) of the femoral arteries?

Femoral popliteal bypass surgery is used to treat a blocked femoral artery. The femoral artery is the largest artery in the thigh. It supplies oxygen-rich blood to the leg. Blockage is due to plaque buildup or atherosclerosis. Atherosclerosis in the leg arteries causes peripheral vascular disease. The same process causes heart disease and stroke.

There are 2 methods used to treat a blockage of the femoral arteries.

Femoral popliteal bypass. The surgeon reaches the femoral artery through a large cut (incision) in the upper leg. A vein taken from another area in your leg is attached above and below the blockage. This is called a graft. The blood is rerouted through the graft around the blockage. In some cases, an artificial graft may be used, rather than a vein graft.
Percutaneous transluminal angioplasty (PTA) of the femoral arteries. Percutaneous transluminal angioplasty is a minimally invasive procedure. That means it’s done without a large cut (incision). Instead, the surgeon uses a long hollow tube (catheter) inserted into the femoral artery and guides it to the narrowed area. There is a tiny balloon at the catheter tip is inflated compressing the fatty tissue. This makes a larger opening in the artery for better blood flow. A tiny, expandable metal mesh coil (stent) may be put in the newly opened area of the artery. It helps keep the artery from narrowing or closing again.

Why might I need a femoral popliteal bypass surgery?

You may need a femoral popliteal bypass surgery for:

Lifestyle changes and medicine have not improved symptoms. Or symptoms are worse.
Leg pain that interferes with daily life or ability to work
Wounds that don't heal
Infection or gangrene
Leg pain at rest
Danger of losing the limb due to decreased blood flow

There may be other reasons for your healthcare provider to recommend femoral popliteal bypass surgery.

What are the risks of the femoral popliteal bypass surgery?

Some possible complications may include:

Heart attack
Irregular heart beats
Bleeding
Wound infection
Swelling of the leg
Blood clot in the leg
Fluid in the lungs
Bleeding where the catheter is put in after the procedure
Blood clot or damage to the blood vessel where the catheter is put in
Re-stenosis
Nerve injury
Blockage in the graft used in bypass surgery

There may be other risks based on your condition. Talk about any concerns with your healthcare provider before the procedure.

How do I get ready for femoral popliteal bypass procedure?

Recommendations for preparation include:

Your healthcare provider will explain the procedure and you can ask questions.
You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
Your provider will review your medical history and do a physical exam to be sure you are in good health before you have the procedure. You may also have blood tests and other diagnostic tests.
Your healthcare provider may recommend taking an aspirin before the procedure.
You will be asked to fast for 8 hours before the procedure. This means not eating, drinking, or taking any oral medicines after midnight.
If you are pregnant or think you could be, tell your healthcare provider.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.
Tell your healthcare provider of all medicines (prescribed and over-the-counter), vitamins and herbal supplements that you are taking.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
If you smoke, stop smoking as soon as possible before the procedure. This will help your recovery and your overall health.
You may get a sedative before the procedure to help you relax.
Tell your healthcare provider if you have a pacemaker.
Follow any other instructions your provider gives you to get ready.

What happens during femoral popliteal bypass surgery?

Talk with your healthcare provider about what you will experience during your procedure. These procedures require a hospital stay. Procedures may vary based on your condition and your provider's practices.

Femoral popliteal bypass surgery

Generally, femoral popliteal bypass surgery follows this process:

You will need to remove any jewelry or other objects that may interfere with the procedure.
You will need to remove your clothing and put on a hospital gown.
An IV (intravenous) line will be started in your arm, hand, or collarbone area. More catheters may be put in your neck and wrist to keep track of your heart and blood pressure, and to get blood samples.
You will lie on your back on the operating table.
If there is too much hair at the surgical site, it may be shaved off.
The anesthesiologist will monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. You will be connected to a heart monitor that records the electrical activity of the heart during the procedure.
A femoral popliteal bypass may be done under local anesthesia. You will not feel the area to be operated on. You will get medicine in your IV to help you relax before the procedure. But you will likely stay awake, but feel sleepy, during the procedure.
Under local anesthesia, you will get oxygen through a tube that fits in your nose.
Femoral popliteal bypass may also be done under general anesthesia. You will be asleep. Once you are sedated, your provider will put a breathing tube through your throat into your lungs. You will be connected to a ventilator. It will breathe for you during the surgery.
A catheter will be inserted into your bladder to drain urine.
You will be given antibiotics through your IV to help prevent infection.
The skin over the surgical site will be cleaned.
The surgeon will make an incision in the leg. The site of the incision will depend on the section of the arteries to be bypassed. The surgeon will determine whether to use a man-made graft or a vein from the leg to bypass the diseased artery.
Once the surgeon has attached the graft onto the diseased artery, a type of X-ray called an arteriogram may be done to make sure that blood flow has been restored to the leg through the new bypass graft.
You may get blood pressure medicine through your IV during and after the procedure to keep your blood pressure within a certain range.
The incision will be closed. A sterile bandage or dressing will be applied.

Percutaneous transluminal angioplasty (PTA) of the femoral artery

Generally, a PTA of the femoral artery procedure follows this process:

You will need to remove any jewelry or other objects that may interfere with the procedure.
You will need to remove clothing and put on a hospital gown.
You will be asked to empty your bladder before the procedure.
An IV (intravenous) line will be started in your hand or arm before the procedure to inject medicine and to give IV fluids, if needed.
You will lie on your back on the procedure table.
If there is too much hair at the surgical site, it may be shaved off.
You will be connected to a heart monitor that tracks the electrical activity of the heart during the procedure. Your provider will watch your heart rate, blood pressure, breathing rate, and oxygen level during the procedure.
You will get medicine in your IV before the procedure to help you relax. You will likely stay awake, but feel sleepy, during the procedure.
Your provider will check your pulses below the insertion site before and after the procedure.
Your provider will inject a local anesthetic into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.
Once the local anesthetic has taken effect, your surgeon will insert a sheath, or introducer, into the blood vessel. The catheter will be inserted into the femoral artery through this plastic tube.
Your provider will put a special catheter or guide wire into the femoral artery and move it to the site of the blockage using X-ray guidance.
The position of the catheter may be confirmed by injecting a small amount of contrast dye into the artery, which may then be seen on a monitor.
The surgeon will insert an angioplasty catheter and advance it to the location of the blockage. The surgeon will inflate a balloon at the tip of the catheter. This opens the artery.
The surgeon may inflate and deflate the balloon several times to open the artery. In some cases, they may insert a tiny, expandable metal mesh coil (stent) to help keep the artery from narrowing or closing again.
Once it has been determined that the artery is opened, the angioplasty catheter will be removed.
Your surgeon may close the insertion site with a device that uses collagen to seal the opening in the artery, or with stitches. Your surgeon will determine which method is best for you.
A sterile dressing or bandage will be applied.

What happens after femoral popliteal bypass?

In the hospital after femoral popliteal bypass

After the procedure, you will be taken to the post anesthesia care unit (PACU) and closely watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room.

Your surgeon will check your pulses below the surgical site often to check blood flow to the limb. They will also check your leg for color (pale or pink), warmth, pain, and movement.

The incision may be sore for several days after the procedure. Take pain relievers as advised by your provider.

You may be on special IV medicine to help your blood pressure and your heart, and to control any problems with bleeding. As you stabilize, your provider will gradually decrease, and then stop, these medicines.

You can return to eating solid foods as you are able to handle them.

When your healthcare team decides you are ready, they will move you to a postsurgical nursing unit. Your recovery will continue. You can gradually increase your activity as you get out of bed and walk around for longer periods.

Arrange for a follow-up visit with your surgeon.

In the hospital after PTA of the femoral artery

You will be taken to the PACU and closely watched after the procedure. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the ICU or your hospital room.

Tell your nurse right away if you feel any chest pain or tightness, or any other pain. Or any feelings of warmth, bleeding, or pain at the insertion site.

The nurse will help you the first time you get up. Move slowly when getting up from the bed so you don’t get dizzy.

You may be given pain medicine for pain or discomfort where the catheter was inserted or from having to lie flat and still for a long period.

You can start to eat solid foods as you can handle them.

Your hospital stay will depend on your condition and the results of your procedure. You will get detailed instructions for your discharge and recovery period.

Arrange for your follow-up visit with your surgeon.

At home after femoral popliteal bypass

Once you are home, it will be important to keep the surgical area clean and dry. Your healthcare provider will tell you how to bathe.

You may be told not to do any strenuous activities. Your provider will tell you when you can return to work and normal activities.

Your provider may want you to keep taking blood thinning medicine after the procedure.

Your provider may do an ultrasound on your leg after surgery to check the new graft.

Call your provider right away if you have any of these:

Fever or chills
Increased pain, redness, swelling, or bleeding or other fluid leaking from the leg incision
Coolness, numbness, or tingling, or other changes in the affected leg
Chest pain or pressure, nausea or vomiting, heavy sweating, dizziness, or fainting

Your provider may give you other instructions after the procedure.

At home after PTA of the femoral artery

Once at home, check the insertion site for bleeding, unusual pain, swelling, and abnormal color or temperature change at or near the insertion site. A small bruise is normal.

Call your healthcare provider right away if you notice a constant or large amount of blood at the site that can't be contained with a small dressing.

You will be given specific information about how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was. This is normal. The knot should go away over a few weeks.

It’s important to keep the insertion site clean and dry. Your provider will give you specific bathing instructions.