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FEMORO-POPLITEAL BYPASS

This procedure is performed in those patients with symptomatic Peripheral Vascular Disease (PVD), where the blockage in the superficial femoral artery and/or popliteal artery cannot be treated with an endovascular (balloon or stent) procedure.

Patients may be experiencing muscle pain on walking (referred to as intermittent claudication), or in more severe cases pain in the foot at rest (referred to as rest pain) or even non-healing leg ulceration or tissue loss.

Pre-operative preparation

In order to prepare for this procedure, it is vital that a full medical work-up be obtained to confirm fitness for anaesthesia.

This will involve a number of blood tests, and an assessment of the heart with an ECG, thallium scan, and referral to a cardiologist if there are any concerns about your heart.

As the best choice for the vascular tube (or conduit) for the bypass is the patient’s own saphenous vein of that limb, the leg is scanned using ultrasound to confirm the vein’s suitability. If there is no suitable vein, a prosthetic graft (PTFE) will be used.

Day of procedure

You may be admitted on the morning of the procedure if your work-up has been completed. You will be required to bring ALL of your usual medications.

It is important to fast for at least 6 hours prior to the procedure. For a morning procedure, you will need to fast from midnight, whereas for an afternoon procedure, this will mean fasting from 7am.

Your anaesthetist will consult you prior to the operation, and explain the anaesthetic and its risks to you.

The procedure

A full general anaesthetic is administered, and a tube inserted into your windpipe (trachea) to help with your breathing while you are asleep. A catheter is also inserted into your bladder to help in monitoring your fluid status. This will remain for the first 48 hours.

The operation is performed on the affected leg.

If the vein is known to be suitable, it is removed (harvested) through an incision extending from just below the knee to the groin. The femoral artery is exposed in the groin and the popliteal artery is exposed either above or below the knee, depending on which site is the more appropriate.

Heparin is administered to help keep the blood thin. The graft (vein or prosthetic) is joined (anastomosed) to the popliteal artery and to the femoral artery, thereby bypassing the blockage in the thigh. This restores the circulation to the lower part of the leg.

The wound(s) are closed and dressed, with suction drains placed in both wounds. Antibiotics are commenced at the time of surgery, and are continued for 48 hours, until all lines and catheters are removed.

Post-operative course

All patients are monitored closely for the first 24 hours. This can be conducted on the ward or the intensive care unit.

Patients are then transferred to the ward, where oral fluids and diet are slowly re-introduced, and mobilisation commenced. It is a gradual process, but most patients are fit for discharge after 5 to 7 days.

Following Discharge

You are encouraged to be active within your comfort zone.

If you encounter any discomfort or wound problems, contact the rooms immediately.

A routine follow-up appointment to see Mr Bell will be made for 2 weeks.