Femoral-tibial bypass surgery for peripheral arterial disease
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 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 polytetrafluoroethyline [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 existing blockage(s). See a picture of a femoral-tibial bypass.
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
Because this surgery is done on blood vessels that are near the surface of the legs, recovery times are shorter than for an aortobifemoral bypass, which requires surgery inside the abdomen.
You will need to stay in bed for 1 to 2 days after surgery. You will need to stay in the hospital for 3 to 5 days.
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 blocked femoral and popliteal arteries too. See a picture of peripheral arterial disease. Usually, the blockage must be causing severe symptoms or be limb-threatening before bypass surgery is considered.
How Well It Works
When a vein is used, the bypass remains open in 74% to 80% of people 5 years after surgery. But man-made (prosthetic) grafts are less effective for this type of surgery. When a man-made graft is used, the graft remains open in about 25% of people 3 years after surgery.1
Surgical risks include:
- Failed or blocked grafts.
- Heart attack or stroke.
- Leg swelling if a leg vein is used.
What To Think About
Bypass surgery is preferred for people who have many areas of blockage or a long, continuous blockage.
Angioplasty may be preferred for people who have a small number of short, narrowed areas in the arteries of the leg or pelvis.
- 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.
Last Updated: October 16, 2009