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With the help of a natural or synthetic graft, a surgical bypass routes blood flow around an area of blockage caused by peripheral arterial disease (PAD). While the surgery does not cure the disease or remove the blockage, it can significantly improve the health of your arteries. In the leg, this is called a lower extremity bypass – think of it as a road detour.

A surgical bypass may help you if you have PAD and have symptoms such as leg muscle pain while walking, pain at night, especially in the feet, feet and leg sores that won’t heal and dead tissue.

Usually, other therapy is tried first, such as medication, exercise, quitting smoking and wound care. If these fail and alternative treatment such as a balloon angioplasty and stenting is not suitable, then tests may be performed to assess the possibilities of a surgical bypass.

Who is a candidate?

Good candidates for extremity bypass surgery includes those with a blockage or narrowing of one or more arteries caused by PAD.

What to expect

For extremity bypass surgery, you’ll be given a general or spinal anesthetic so that you will feel no pain during the operation. If needed, you will be given a blood transfusion.

  • A fem-pop bypass, the most common type, uses a natural or synthetic graft to create the detour around the blockage beginning at your groin/thigh crease and ending at the inner knee, or sometimes the calf or foot.
  • An incision, about 4-8 inches long, is made at the groin crease and again at the end point.
  • If your own vein is used to create the graft, other small incisions may be made on the inner portion of the thigh. Otherwise, a synthetic tube made of fabric or plastic will be used.
  • The graft is sewn to the artery at both ends with fine stitches.
  • Surgery can take 1.5–6 hours.

You can expect to be in the hospital for 2-5 days for monitoring and recuperation. The bowels often go to sleep for several days, so food is re-introduced gradually. You’ll have incision pain/discomfort for several days/weeks, treated with pain medication. Typically, there is swelling and sometimes drainage. Sometimes, patients will go to a rehab facility for a few days after leaving the hospital to regain strength.

When you go home, it is wise to have someone stay with you for a few days. You will be able to ride in a car and walk up steps, but you will need time to recuperate before driving or doing heavy work – how long depends on your condition and type of bypass. You may lose your appetite for a while and lose some weight. Often, there is swelling of the leg, and numbness around or drainage from the incision. You’ll get instructions on how to treat these symptoms.

Muscle pain with walking should improve/resolve and wounds should heal.

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