What is Femorofemoral Bypass
Femorofemoral bypass (or femoral-femoral bypass) is a surgery to improve blood flow (circulation) in the legs. You may need this procedure if your iliac artery is blocked.
The iliac artery is one of the main blood vessels that supplies blood to the legs. One branch of the iliac artery (external iliac artery) becomes the femoral artery as it reaches the leg. The femoral artery is a common site of blockage. You may have this procedure if you have reduced circulation that:
- Causes pain.
- Puts you at risk for infection.
- Puts you at risk for needing surgical removal of the leg (amputation).
- Has not been helped by other treatments.
During this procedure, an artificial blood vessel (prosthetic graft) is placed so that it connects the left and right femoral arteries to each other. This allows blood to flow around (bypass) the blocked part of the iliac artery, resulting in improved circulation to your leg.
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:
- Infection.
- Bleeding.
- Allergic reactions to medicines or dyes.
- Nerve damage.
- A blood clot that blocks the graft (thrombosis).
- Lung infection (pneumonia).
- A blood clot that forms in the leg or the graft and may travel to the lung (pulmonary embolism).
- Heart attack.
- Stroke.
What happens before the procedure?
Medicines
- 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 unless your health care provider tells you to take them.
- Taking over-the-counter medicines, vitamins, herbs, and supplements.
Staying hydrated
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating and drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
Bathing
- You may be asked to shower with a germ-killing (antiseptic) soap.
- Do not shave your abdomen or groin area.
General instructions
- Ask your health care provider how your surgical site will be marked or identified.
- You will have an imaging test of the arteries that supply blood to your legs.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
- Plan to have someone take you home from the hospital or clinic.
- Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash or sanitize their hands.
- Hair may be removed from the surgical area.
- Your skin will be washed with soap.
- An IV will be inserted into one of your veins.
- In
most cases, you will be given a medicine to make you fall asleep (general
anesthetic). If general anesthesia is not safe for you because of a
heart or lung condition, you will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to numb the area (local anesthetic).
- A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
- You will be given antibiotic medicine through your IV to prevent infection.
- An incision will be made on each side of your groin, above your left and right femoral arteries.
- The femoral arteries will be located.
- A tunnel will be made to connect the two incisions.
- A prosthetic graft will be threaded through the tunnel. (In some cases, a human blood vessel may be used for the graft.)
- You will be given medicine through your IV to prevent blood clots.
- Your femoral arteries will be clamped above your incisions to temporarily stop blood flow.
- A hole will be made in each femoral artery.
- The ends of the graft will be stitched (sutured) onto the holes in the left and right femoral arteries.
- The femoral artery clamps will be removed.
- To make sure blood is flowing through the graft, an imaging test (ultrasound) may be done. Your surgeon may also check the pulses in your feet.
- Your incisions will be closed with sutures or surgical clips.
- Your incisions may be covered with bandages (dressings).
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 until the medicines you were given have worn off.
- You
will be encouraged to:
- Get out of bed and start walking as soon as you are able.
- Do deep breathing exercises several times a day to prevent pneumonia.
- You
will be given:
- Pain medicine as needed.
- IV antibiotics.
- IV medicines to prevent blood clots.
- You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
- Do notdrive until your health care provider approves.
Summary
- Femorofemoral bypass (or femoral-femoral bypass) is a surgery to improve blood flow (circulation) in the legs.
- The iliac artery is one of the main blood vessels that supplies blood to the legs. One branch of the iliac artery (external iliac artery) becomes the femoral artery as it reaches the leg. Blockages often happen in the femoral artery.
- This procedure may be the best treatment for you if a reduced blood supply to one leg causes pain or puts your leg at risk for an infection or amputation.
- After the bypass procedure, the blood will flow around (bypass) the blocked part of the iliac artery.
Femorofemoral Bypass, Care After
This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.
What can I expect after the procedure?
After the procedure, it is common to have:
- Discomfort or pain around your incisions that can be relieved by taking medicine.
Follow these instructions at home:
Medicines
- Take over-the-counter and prescription medicines only as told by your health care provider.
Bathing
- Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
Incision care
- Follow
instructions from your health care provider about how to take care of your
incisions. Make sure you:
- Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
- Change your dressings as told by your health care provider.
- Leave stitches (sutures), staples, 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 areas every day for signs of infection. Check for:
- Redness, swelling, or more pain.
- Fluid or blood.
- Warmth.
- Pus or a bad smell.
Activity
- Try to walk regularly at home. This will lower your risk for blood clots. Ask your health care provider how far and how often you should walk.
- Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
- Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
Driving
- Do not drive until your health care provider approves.
- Do not drive or use heavy machinery while taking prescription pain medicine.
Lifestyle
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider. Smoking is bad for blood vessels and delays healing.
If you are taking blood thinners:
- Take your medicine exactly as told, at the same time every day.
- Avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.
- Wear a medical alert bracelet or carry a card that lists the medicines that you take.
Talk with your health care provider before you take any medicines that contain NSAIDs. These medicines increase your risk for dangerous bleeding.
General instructions
- If
you are taking prescription pain medicine, take actions to prevent or
treat constipation. Your health care provider may recommend that you:
- Drink enough fluid to keep your urine pale yellow.
- Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
- Limit foods that are high in fat and processed sugars, such as fried or sweet foods. Limiting these foods also helps your blood vessels stay healthy.
- Take an over-the-counter or prescription medicine for constipation.
- Wear compression stockings if recommended by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
- Before you have any type of procedure or surgery, tell all health care providers including your dentist that you have a graft. You may need to take antibiotics to prevent graft infection.
Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have pain that does not get better with medicine.
- You have chills or a fever.
- You have redness, swelling, or more pain around an incision.
- You have fluid or blood coming from an incision.
- An incision feels warm to the touch.
- There is pus or a bad smell coming from an incision.
- You develop a cough.
- You have shortness of breath.
- You have leg pain when you walk.
Get help right away if:
- You have severe pain.
- You have chest pain.
- You have difficulty breathing.
- You have redness, swelling, pain, or warmth in your leg.
Summary
- Follow instructions from your health care provider about medicines, diet, activity restriction, and incision care.
- Let your health care provider know if you have any signs of infection, such as redness, swelling, or more pain.
- Get help right away if you have chest pain or trouble breathing.
