Femoral Popliteal Bypass

About Femoral Popliteal Bypass

Femoral popliteal bypass is an operation that reroutes blood around a blocked or severely narrowed superficial femoral artery in the thigh, a common site of peripheral artery disease. It is performed for disabling claudication, pain in the leg muscles during walking, and for chronic limb threatening ischemia, which causes rest pain, non healing ulcers or gangrene and threatens limb loss. A conduit is connected to the common femoral artery in the groin above the blockage and to the popliteal artery above or below the knee. The great saphenous vein of the patient is the preferred conduit, either reversed or left in place with its valves disrupted, because it remains open longer than synthetic grafts, particularly when the bypass extends below the knee; prosthetic grafts made of PTFE or Dacron are used when no suitable vein is available. Endovascular treatments such as balloon angioplasty, stents and atherectomy have reduced the number of bypass operations, but surgical bypass remains important for long or complex blockages and after failed endovascular treatment, and the BEST CLI trial compared the two strategies in people with chronic limb threatening ischemia. Complications include graft blockage, infection, particularly of prosthetic grafts, wound healing problems, leg swelling and heart attack or stroke related to widespread atherosclerosis. Graft surveillance with duplex ultrasound is used to detect narrowing before the graft fails. Medical treatment of atherosclerosis, including antiplatelet drugs, statins, blood pressure control and stopping smoking, is a central part of overall care.