Heart Disease Health Center

Most of the time, surgery is only done in cases of severe peripheral arterial disease (PAD), such as disabling intermittent claudication; open sores (ulcers that won't heal); or serious skin, bone, and tissue problems (gangrene).

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.

The methods of bypass surgery vary depending on the size of the affected artery and where it is located.

Peripheral Arterial Disease: Should I Have Surgery?

Surgery choices

The type of surgery used to treat PAD will depend on 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 .

Endarterectomy is a less common surgery. It 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 to 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

In rare cases, peripheral arterial disease gets so bad that some people need to have a leg, a 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.

Also 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.