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 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 existing blockage(s).

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 will need to stay in bed for 1 to 2 days after surgery. You will 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

When a vein is used, the bypass remains open in 74 to 80 out of 100 people 5 years after surgery. But man-made (prosthetic) grafts are less effective for this type of surgery. When a man-made graft is used, the graft remains open in about 25 out of 100 people 3 years after surgery.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

Some people want to try lifestyle changes before having this surgery. Making these changes could help you walk without pain. And lifestyle changes don't have the risks of bypass 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, So

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer David A. Szalay, MD - Vascular Surgery
Last Revised October 14, 2011

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