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 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 healthcare provider accesses the femoral artery through a large incision in the upper leg. A blood vessel 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, a man-made graft may be used, rather than a vein graft.
  • Percutaneous transluminal angioplasty (PTA) of the femoral arteries. Percutaneous transluminal angioplasty is a minimally invasive. That means it’s done without a large incision. Instead, the healthcare provider uses a long hollow tube (catheter) inserted into the femoral artery and guided to the narrowed area. There, a tiny balloon at its 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)
  • Non-healing wounds
  • 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, usually the groin 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. Be sure to discuss any concerns with your healthcare provider(s) before the procedure.

How do I get ready for femoral popliteal bypass procedure?

  • 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(s) 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(s).
  • Tell your healthcare provider(s) if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, or anesthesia.
  • Tell your healthcare provider(s) of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your healthcare provider(s) 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(s) 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:

  1. You will need to remove any jewelry or other objects that may interfere with the procedure.
  2. You will need to remove your clothing and put on a hospital gown.
  3. An intravenous (IV) line will be started in your arm, hand, or collarbone area. More catheters may be put in your neck and wrist to monitor your heart and blood pressure, and to get blood samples.
  4. You will lie on your back on the operating table.
  5. If there is too much hair at the surgical site, it may be shaved off.
  6. 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.
  7. 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.
  8. Under local anesthesia, you will get oxygen through a tube that fits in your nose.
  9. 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.
  10. A catheter will be inserted into your bladder to drain urine.
  11. You will be given antibiotics through your IV to help prevent infection.
  12. The skin over the surgical site will be cleaned.
  13. 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.
  14. 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.
  15. You may get blood pressure medicine through your IV during and after the procedure to keep your blood pressure within a certain range.
  16. 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:

  1. You will need to remove any jewelry or other objects that may interfere with the procedure.
  2. You will need to remove clothing and put on a hospital gown.
  3. You will be asked to empty your bladder before the procedure.
  4. An intravenous (IV) line will be started in your hand or arm before the procedure to inject medicine and to give IV fluids, if needed.
  5. You will lie on your back on the procedure table.
  6. If there is too much hair at the surgical site, it may be shaved off.
  7. You will be connected to a heart monitor that monitors the electrical activity of the heart during the procedure. Your provider will monitor your heart rate, blood pressure, breathing rate, and oxygen level during the procedure.
  8. You will get medicine in your IV before the procedure to help you relax. But you will likely stay awake, but feel sleepy, during the procedure.
  9. Your provider will check your pulses below the insertion site before and after the procedure.
  10. 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.
  11. Once the local anesthetic has taken effect, your provider will insert a sheath, or introducer, into the blood vessel. The catheter will be inserted into the femoral artery through this plastic tube.
  12. Your provider will put a special catheter or guide wire into the femoral artery and move it to the site of the blockage.
  13. 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.
  14. The provider will insert an angioplasty catheter and advance it to the location of the blockage. He or she will inflate a balloon at the tip of the catheter. This opens the artery.
  15. The provider may inflate and deflate the balloon several times to open the artery. In some cases, he or she may insert a tiny, expandable metal mesh coil (stent) to help keep the artery from narrowing or closing again.
  16. Once it has been determined that the artery is opened, the angioplasty catheter will be removed.
  17. Your provider may close the insertion site with a device that uses collagen to seal the opening in the artery, or with sutures. Your provider will determine which method is best for you.
  18. A sterile dressing or bandage will be applied.

What happens after femoral popliteal bypass?

In the hospital—femoral popliteal bypass

After the procedure, you will be taken to the recovery room and 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 healthcare provider will check your pulses below the surgical site often to check blood flow to the limb. He or she will also watch your leg for color (pale or pink), warmth, sensations of pain, and movement.

The incision may be tender or sore for several days after the procedure. Take a pain reliever as recommended by your doctor.

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 determines that you are ready, you will be moved from the ICU 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 doctor.

In the hospital—PTA of the femoral artery

After the procedure, you will be taken to the recovery room at 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.

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

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 healthcare provider.

At home—femoral popliteal bypass

Once you are home, it will be important to keep the surgical area clean and dry. Your 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.

Tell your provider if you have any of the following:

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

Your provider may give you other instructions after the procedure, based on your situation.

At home—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.

Tell your provider if you notice a constant or large amount of blood at the site that cannot 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.

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

Tell your provider if you have any of the following:

  • Fever or chills
  • Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
  • Coolness, numbness or tingling, or other changes in the affected leg
  • Chest pain/pressure, nausea and/or vomiting, heavy sweating, dizziness, or fainting

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure