Peripheral Artery Bypass Surgery

What is peripheral artery bypass surgery?

Peripheral artery bypass surgery improves blood circulation in your legs when you have peripheral artery disease. Our surgeons use either a blood vessel from your leg or a graft made from surgical-grade synthetic material to reroute blood flow around a blockage—like creating a detour around a traffic jam.

Other names for this vascular procedure include leg bypass procedure and peripheral vascular bypass. “Vascular” refers to blood vessels. “Peripheral” means the blood vessels in the arms or legs.

Our vascular surgeons perform a high volume of peripheral artery bypass surgeries with excellent results. These experts specialize in treating conditions that affect your blood vessels (vascular system). 

Who needs peripheral artery bypass surgery?

Your healthcare provider may recommend peripheral artery bypass surgery if you have peripheral artery disease (PAD) with severe symptoms, such as a non-healing wound or constant pain in your feet caused by blocked blood vessels. More than 8 million Americans have PAD.

PAD occurs when a fatty substance called plaque builds up inside arteries that carry oxygenated blood from your heart to your lower limbs. Plaque clogs the arteries, restricting blood flow and making the blood vessels less flexible. This condition, called arteriosclerosis, causes the arteries to narrow and harden.

PAD usually affects blood flow in one leg. It’s less common for PAD to affect both legs or your arms. PAD can cause muscle pain when you’re active that eases when you rest (called claudication). Severe blockages can cause critical limb ischemia, which may lead to limb loss. Lack of blood flow can also cause nonhealing wounds that increase your risk for infection and gangrene (tissue death from lack of blood supply).

Medications, exercise, and lifestyle changes can ease mild to moderate PAD symptoms. If these approaches are not effective—or if PAD significantly affects mobility and quality of your life—your provider may recommend surgery. Your care team will consider several factors, such as your health history and disease severity, to determine if peripheral artery bypass surgery is right for you.

Types of peripheral artery bypass surgery

There are different ways to perform peripheral artery bypass surgery. The type of surgery you need depends on the location of the affected arteries. Your care team will discuss treatment options with you.

Common types of bypass surgery include:

• Femoropopliteal bypass surgery (fem-pop bypass) is the most common leg bypass surgery. It treats blood vessel blockages above your knee.
• Femoral-tibial bypass surgery (also called distal bypass) treats blood vessel blockages in your lower leg or foot.
• Aortobifemoral bypass surgery treats blockages in large blood vessels in your abdomen and groin, improving blood flow to your legs.

Benefits of peripheral artery bypass surgery

Peripheral artery bypass surgery improves blood flow to your legs, easing PAD symptoms and improving your quality of life. Surgery helps to:

• Minimize pain, so you can walk and be more physically active
• Improve wound healing
• Lower the risk of wound infections, gangrene, and limb loss

Risks of peripheral artery bypass surgery

All surgeries carry some risks. However, our expert vascular surgeons perform a high volume of peripheral artery bypass surgeries every year. Our team’s deep expertise helps minimize complications while providing excellent results.

Potential surgical risks include:

• Bleeding
• Blood clots and stroke
• Graft failure (limited blood flow through the graft)
• Heart attack
• Infection

Preparing for peripheral artery bypass surgery

Your care team will explain how to prepare for this procedure. Before surgery, you may need to:

• Complete blood tests and other screenings
• Get a vascular ultrasound, electrocardiogram (ECG/EKG), and other tests to evaluate the veins of your legs
• Change or stop taking certain medications in the days leading up to surgery
• Avoid eating or drinking the day of surgery
• Stop smoking, if needed
• Prepare for any at-home, postsurgical support 

What to expect during peripheral artery bypass surgery

The steps for leg bypass surgery depend on the surgery type, your anatomy, and overall health. You will receive anesthesia that puts you to sleep, as well as IV blood-thinning medications to prevent blood clots.

During fem-pop bypass surgery, one of our highly skilled vascular surgeons:

1. Makes an incision to access and remove a healthy vein from the unaffected leg to use as the bypass graft. This step isn’t needed when using a synthetic graft.
2. Makes incisions above and below the blocked artery section.
3. Clamps off the blocked section of artery to stop blood flow.
4. Stitches one end of the vein or lab-made graft onto the diseased artery below the blockage, and the other end of the graft above the blockage.
5. Checks to make sure blood flows through the bypass graft.
6. Closes the incisions.

Recovery after peripheral artery bypass surgery

You’ll recover in our hospital for up to five days. Everyone’s recovery is different, so it’s possible you may need to stay longer. During your stay, we monitor your vital signs and manage any pain. You’ll meet with physical therapists who will help you regain strength and mobility.

Before discharge, your care team will provide instructions for at-home wound care and activity restrictions. Some patients need:

• Antibiotics to prevent infection
• Cholesterol-lowering medications (statins) to prevent plaque from building up in the bypass graft
• Pain medications to ease discomfort at the incision site

After surgery, you’ll see your care team for regular checkups and imaging tests to check the bypass graft. You may need to take aspirin or antiplatelet medications for life to prevent blood clots that cause strokes. Your provider may recommend participating in physical therapy or cardiac rehabilitation after discharge. 

FAQs about peripheral artery bypass surgery