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 narrowed or 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 diseased area.
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 may 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 narrowed or blocked femoral and popliteal arteries too. Usually, a person has severe symptoms or the problem is limb-threatening before bypass surgery is considered.
How Well It Works
All surgeries carry a certain amount of risk. These risks include:
Specific risks for this bypass surgery include:
- Leg swelling.
- Failed or blocked grafts.
What To Think About
Your doctor may recommend that you try an exercise program and medicine before he or she recommends that you have this surgery.
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, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11): e463-e654.
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical ReviewerDavid A. Szalay, MD - Vascular Surgery
Current as ofFebruary 20, 2015