Femoral Popliteal Bypass

What is Femoral Popliteal Bypass

Femoral popliteal bypass is a procedure to go around (bypass) a blocked artery in the leg. The artery may become blocked with plaque, which is a buildup of fat. Arteries carry oxygen and nutrients to the body.

The femoral artery is in the upper part of the leg. It is the main artery that carries blood to the leg. Popliteal arteries are in the back of the knee. These arteries take blood to the lower part of the leg.

This procedure uses a graft to bypass the blocked artery. The graft can be one of your own veins that has been taken from another part of your leg, or it can be made of a manufactured material, such as plastic or fabric.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Blood clots that form in the graft or the leg and block blood flow.
• Blood clots that form and break loose. These can travel to the lungs or the brain and cause breathing difficulty or a stroke.
• Failure of the procedure.
• Infection.
• Nerve damage.
• Heart attack.
• Pneumonia.
• Damage to other structures or organs.
• Allergic reactions to medicines or dyes.

What happens before the procedure?

Follow instructions from your health care provider about eating or drinking restrictions.

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have tests, including:
  • Blood tests.
  • A test to check your heart’s rhythm (electrocardiogram).
  • A test to look inside your arteries to see how the blood is flowing (angiogram).
• Do notuse tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• A thin tube (catheter) will be placed into your bladder to drain urine during and after the procedure.
• You may be given antibiotic medicine through your IV tube.
• If the graft will come from one of your own veins (autograft):
  • An incision will be made in your leg near the portion of the autograft vein that will be used.
  • After the autograft is removed, this incision will be closed.
• An incision will be made in your groin area so your surgeon can locate your femoral artery.
• A clamp will be placed above the area where the femoral artery is blocked.
• The graft will be sewn into the artery above the blocked area.
• Another incision will be made lower in the leg over the popliteal artery. This is usually behind the knee.
• The popliteal artery will be clamped. Then, the other end of the graft will be brought down under the skin between the two incisions.
• The free end of the graft will be sewn into the popliteal artery.
• The clamps will be removed, and the attachments will be checked for leaking.
• You may have an X-ray done after a dye is injected. This is to check the blood flow through the graft (arteriogram).
• As soon as blood is flowing through and is not leaking, the incisions will be closed with sutures or staples.
• Bandages (dressings) will be applied.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.

• You may be given medicine for pain.
• Your IV tube and your catheter may be removed when you are taking fluids well and passing urine.
• You may be given blood thinner medicine to prevent blood clots.
• Your health care provider may recommend that you wear compression stockings. These help to prevent blood clots and reduce swelling in your legs.
• Your surgical site will be checked often to make sure that you have good blood flow in your leg. Health care providers will feel for a pulse on your foot. Your leg will also be checked for changes in color and temperature and for decreased feeling (sensation).
• You will be encouraged to get up and walk as soon as you are able. This helps to prevent blood clots.
• Do notdrive for 24 hours if you received a sedative.

Femoral Popliteal Bypass, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Discomfort or pain near the incision.
• Swelling in your leg or foot.
• Numbness in your groin, lower leg, or foot.

Follow these instructions at home:

Bathing

• Do nottake baths, swim, or use a hot tub until your health care provider approves.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Do notdrive for 24 hours if you received a sedative.
• Do notdrive or operate heavy machinery while taking prescription pain medicine.

Activity

• Do notdo any heavy lifting, physical work, or strenuous exercise until your health care provider has approved. Ask your health care provider about specific lifting restrictions.
• Walk regularly as told by your health care provider. This helps with healing and helps to prevent blood clots from forming.
• Until your health care provider approves:
  • Do nottake long car trips.
  • Do nottravel by air.
• Do notsit or stand for long periods of time. When you sit or lie down, raise (elevate) your legs above the level of your heart.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Lifestyle

• Do notuse tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
• Exercise regularly or as told by your health care provider. Talk with your health care provider before you start a new exercise plan.
• Eat a heart-healthy diet. You may need to eat less of some types of food. Good choices are foods that are low in saturated fats. Vegetables, fruits, and whole grains are good for you.
• Maintain a healthy weight. Talk with your health care provider if you need help.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take your antibiotic medicine as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Medicine does not help your pain.
• You feel nauseous or you vomit.
• You have a change in the consistency or frequency of your bowel movements.
• You feel weak and tired for more than a week after your procedure.
• You have a fever.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have bleeding from the incision that does not stop after heavy pressure has been applied for 30 minutes.
• You have chest pain.
• You faint.
• Your pain is severe.
• You are short of breath or you have trouble breathing.
• Your leg or foot becomes cold, pale, or numb.
• You have red streaks coming from the incision.