Peripheral Arterial Disease of the Legs - Surgery
Bypass surgery in the leg arteries may be used to treat severe or limb-threatening peripheral arterial disease (PAD) that is causing symptoms. Bypass surgery redirects blood through a grafted blood vessel to bypass the blood vessel that is damaged. The grafted blood vessel may be a healthy natural vein or artery, or it may be man-made.
You may need surgery if you have symptoms of intermittent claudication and one of the following conditions:
- Your lifestyle or job is limited because of your symptoms.
- Exercise has not relieved your symptoms.
- Medicines have not relieved your symptoms.
The methods of bypass surgery vary depending on the size of the affected artery and the location of the artery.
Surgery Choices
The types of surgery used to treat
PAD are categorized according to the location of the affected leg artery or
arteries. See a picture of
peripheral arterial disease of the legs 
.
-
Aortobifemoral bypass is done for PAD that affects the major abdominal artery (aorta)
and the large arteries that branch off of it. See a picture of
aortobifemoral bypass .
-
Femoropopliteal (fem-pop) bypass is done for PAD that
affects the arteries above and below the knee. See a picture of
femoropopliteal bypass .
-
Femoral-tibial bypass is done for PAD that affects the
arteries in the lower leg or foot. See a picture of
femoral-tibial bypass .
A less common surgery is called an endarterectomy. An endarterectomy is typically done on the large femoral artery, which is in your groin and upper thigh area. This surgery is done to remove fatty buildup (plaque) and increase blood flow to the leg. This surgery is done by cutting open the femoral artery and removing the plaque. This surgery may be done by itself, or it may be done at the same time as bypass surgery or angioplasty.
What to Think About
Surgery for peripheral arterial disease is used for people who have disabling intermittent claudication; pain when at rest; open sores (ulcers) that won't heal; or dying skin, muscle, bone, and nerve tissue in their legs or feet (gangrene).
More than one type of surgical procedure may be done at the same time. For example, a bypass surgery may be done at the same time as a less invasive angioplasty procedure. These procedures may be done at the same time to treat different levels of disease and different-sized arteries.
In rare cases, peripheral arterial disease gets so bad that some people need to have a leg, foot, or part of the foot amputated. People with diabetes are at increased risk for amputation. Amputation is used only when the damage is very severe, possibly life-threatening, and after all other treatment options have been tried.
In rare cases, a blood clot in an artery can suddenly and completely block blood flow to a leg or foot. Often, severe pain, numbness, and coldness develop within 1 hour. This blockage is an emergency. Clot-dissolving medicines, surgical removal of the clot, or bypass surgery is needed to restore blood flow.
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