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Femoral popliteal bypass

What is Femoral Popliteal bypass?

Femoral popliteal bypass is an surgical opening of the upper leg to see directly & visualize the femoral artery, this procedure is done to bypass the blocked portion of the artery using a piece of another blood vessel, blood vessels or vein grafts are used for the bypass,pieces of the vein also is taken from the legs to do this procedure. The vein graft is used & attached above the blockage, and the other is attached below the blockage, re-routing the blood flow around the blockage through the new graft to reach the muscle, In certain situations, a prosthetic(artifical material)graft is used for the bypass graft, rather than a vein graft.

Why are femoral bypass surgeries done?

The reasons that these femoral popliteal bypass surgery or PTA of the femoral artery is done, are duet to

  • Due to medical management that has not improved the symptoms, or even worsening of symptoms.
  • Disability which is severe(intermittent caludication which casues interference with day to day lifestyle and in ability to work)
  • Wounds that do not heal
  • Infection/gangrene
  • Lack of oxygen/which results in ischemic rest pain , due to lack of blood flow , danger

There may be other reasons the doctor recommends a femoral popliteal bypass surgery or PTA.

Risks of the procedure

There are some complications that would occur, which include.

  • Myocardial infarction (heart attack)
  • Cardiac arrhythmias (irregular heart beats)
  • Haemorrhage (bleeding)
  • Wound infection
  • Leg edema (swelling of the leg)
  • Thrombosis (clot in the leg)
  • Pulmonary edema (fluid in the lungs)
  • Bleeding at the catheter insertion site (usually the groin) after PTA procedure
  • Blood clot or damage to the blood vessel at the insertion site (PTA)
  • Restenosis (blockage in the blood vessels after PTA procedure)
  • Nerve injury
  • Graft occlusion (blockage in the graft used in bypass surgery)
  • Patients,who are allergic to certain medications,contrast dyes, iodine,shellfish, or any other medication should notify the doctor

There are many other risks depending on the medical condition, these concerns should be discussed with your doctor.

Before the procedure

  • The doctor will explain the procedure to you in detail, and give room to any questions that you may have.
  • The doctor will ask you to sign a consent form which gives him permission to perform the procedure. Read the form carefully
  • The doctor will do a through check up and physical examination to ensure that you are in good health before you undergo the procedure, you will need to certain tests, like blood test and other diagnostic tests.
  • The doctor would recommend, that you take an aspirin prior to the procedure.
  • The doctor will ask you to fast 8 hours prior to the surgery, so you would need to have an early dinner.
  • If you are pregnant, or suspect that you are pregnant you should keep your doctor informed
  • Notify your doctor if you are sensitive to any kind of allergies like medication,latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
  • Keep your doctor informed if you are taking any kind of medication, over-the-counter drugs or any kind of herbal supplements that you are taking
  • Keep your doctor informed if you have a history of any kind of bleeding disorders and if you are taking any kind of anticoagulant(blood thinning) medications, like aspirin, or other medication which can affect blood clotting. The doctor may advise you to stop these medications prior to this procedure.
  • If you are a chain smoker, you would need to stop smoking , in order to improve your chances of a successful recovery from surgery and to also improve your overall health
  • The doctor will prescribe a sedative prior to the procedure for you to relax
  • If you have a pace maker notify your doctor
  • Depending on your medical condition,the doctor would make specific preparation

During the procedure

This procedure , you would need to be hospitalised, for a femoral popliteal bypass surgery, the procedures may vary from person to person, also depending on the doctors practices

For a general femoral popliteal bypass the surgery is as follows:
  • The doctor will instruct you to remove all your jewellery,before the procedure
  • An IV (intravenous line) will be inserted in your hand, and also additional catheters would be inserted in your neck &wrist; to monitor the status of the heart and blood pressure, and also to obtain blood samples. Additional catheters are included in the subclavian , which is under the collarbone area,
  • You will be positioned lying on the operating table lying on your back
  • If there is excess hair on the surgical site, the surgeon would remove it
  • The anaesthesiologist will closely monitor your heart rate, blood pressure, breathing and blood & oxygen level during the surgery. You will be connected to an ECG monitor to record the electrical activity of the heart, and also monitor the heart during the procedure using a small adhesive electrodes
  • Usually a femoral popliteal bypass is performed under local anaesthesia,however you will not feel any kind is sensation the area which needs to be operated on,a sedative will be administered in the IV so that you can relax, however you will likely remain awake during the procedure but sleepy.
  • During the procedure ,under local anaesthesia, you will receive oxygen through a nasal cannula , and a tube that fits in your nose.
  • This procedure can be performed under general anaesthesia,as once you are sedated,a tube will be inserted in your throat , into the lungs and then connected to a ventilator which will help you to breathe during the surgery.
  • A catheter will be inserted into your bladder to drain or the urine
  • A dose of antibiotics will be given to you through the IV, to prevent any infection
  • The surgical site will be cleansed with an antiseptic lotion
  • The doctor will make an incision in the leg, and the site of the incision will depend on the section of the arteries to be bypassed, the doctor will determine whether to use a prosthetic graft or a vein from the leg to conduct the bypass of the diseased artery.

After the doctor has completed to attach the graft onto the diseased artery, an anteriogram is performed to confirm and check the blood flow that has been restored to the leg through the new bypass graft.

The doctor will administer blood pressure medication through the IV during the procedure to keep your blood pressure within a certain range. The incision is then sutured,together and a sterile bandage or dressing will be applied.

After the procedure

While the patient is in the hospital after the femoral popliteal bypass, after the procedure the patient will be taken to the hospital room for observation. Once the blood pressure, pulse and breathing are stable, and you are alert, then the you are taken to a private room at the hospital.

The doctor will check your pulse below the surgical site, to monitor the blood flow to the limb. The limb also will be monitored for colour(pale or pink) warmth (coolness)any kind of sensations pain and movement.

After the surgery the wound may be a little tender,for a few days after the procedure. The doctor would give you a pain reliever for soreness

The doctor would put you on special IV medications to help your blood pressure, and your heart, and also control any problems with bleeding.. As the patient's condition stabilizes, these medications will gradually decrease .

The doctor will advise you with regards to your diet and slow advise you to take solids as tolerated.

The doctor will monitor your profess and then take a decision to move you from the ICU to the post surgical nursing unit. Your condition will gradually improve and then slowly you would increase your activity and slowly walk for long periods of time.

Arrangements will be made for a follow-up visit with your doctor.

In the hospital-PTA of the femoral artery

After the surgery you would be moved from ICU for observation, once your blood pressure, breathing and pulse is stable and breathing are stable , you may be taken to the ICU.

If you have any kind of chest pain or tightness,of any kind of feelings of warmth bleeding or pain at the wound.

Nursing care will assist you after your surgery, to move slowly when getting up from the bed, to avoid any kind of dizziness after you have been in bed for a long period of time after surgery

The doctor will administer pain medication for the discomfort related to the insertion site and also of having to stay in bed and lie on your back for a long period of time.

The doctor will make a decision on how long you will stay in hospital , and when you can be discharged.

The doctor will schedule the next follow-up visit

At home-femoral popliteal bypass
  • The doctor will give you specific instructions when you are home , on how to keep the surgical area clean and dry.
  • The doctor will advise you not to exert yourself in any way with hard activities, and if you are a working person the doctor will tell you when you can go back to work
  • The doctor may continue the medications, such as aspirin , or clopidogrel(plavix) after the procedure
  • The doctor would also to perform ultrasound examination(s) of the leg after the surgery to monitor the new graft
  • If you experience any fever /chills, increased pain, redness , swelling or bleeding or any kind of drainage from the leg incision
  • Numbness,or tingling, or any kind of changes in the affected extremity
  • IF you experience chest pain or pressure,nausea/vomiting profuse seating, dizziness or fainting