Femoral Popliteal Bypass

Femoral popliteal bypass surgery, also called a fem-pop or femoropopliteal bypass, is a surgical procedure performed to bypass a blocked or severely narrowed portion of the femoral artery located in the thigh enabling continuation of blood flow to the popliteal artery which supplies blood to the knee and the lower part of the leg.

Narrowing of the lumen (or inner space) of the femoral artery may occur due to buildup of fat, cholesterol, and calcium deposits. Blood clots may also develop, further diminishing the lumen size. This decreases blood circulation in the leg, causing pain and cramping, cold feet, a burning sensation or tiredness in the legs when walking, and delayed healing of leg wounds.

Indications for a Femoral Popliteal Bypass

A femoral popliteal bypass may be recommended in the following instances:

• Symptoms affect ability to walk and perform other routine activities of daily living.
• Medical management or lifestyle changes fail to improve symptoms.
• Intermittent cramping (known as claudication) is felt at rest.
• Leg wounds or infections fail to heal.
• Severely diminished blood supply, increasing the risk of gangrene and the possible loss of a limb.

Preparation for a Femoral Popliteal Bypass

In preparation for a femoral popliteal bypass, blood tests and diagnostic procedures will be performed.

You will need to inform your doctor about any allergies and medications you take regularly as certain medications such as blood-thinners may have to be stopped temporarily about a week before the procedure. 

You may be asked to avoid eating and drinking after midnight on the day prior to surgery.

You should stop smoking as soon as possible as it delays healing after surgery.

Femoral Popliteal Bypass Procedure

The femoral popliteal bypass procedure involves the following steps:

• An IV line and catheters are placed to monitor your heart and blood pressure.
• You are connected to an ECG to check the electrical activity of your heart.
• You will lie on your back on the operating table.
• Either local or general anesthesia will be administered.
• The skin over the surgical site in the leg will be cleaned with an antiseptic solution.
• An incision is made in the skin to access the diseased part of the artery.
• A portion of a healthy blood vessel or a graft is sewn above and below the diseased portion of the artery.
• A special X-ray called an arteriogram is taken to ensure blood is flowing through the bypass graft or vessel.
• The incision is closed with sutures and a bandage is applied over the incision site.

Recovery and Post-procedure care

After surgery, you will be transferred to the recovery room for monitoring of vital signs and to ensure there are no complications from the surgery. You may have to stay in the hospital for 2 to 4 days. There may be pain and swelling at the incision site, for which medications will be provided. Instructions will be given on how to care for the incision site. You should avoid strenuous activity for about 2 to 6 weeks and may return to work with your doctor’s approval.

Risks and Complications 

Femoral popliteal bypass is a safe procedure; however, there are some risks and complications involved that include:

• Pain and infection of the incision site
• Swelling of the leg
• Formation of clots in the graft
• Nerve injury
• Heart and lung problems

Summary

Femoral popliteal bypass is a surgery performed to bypass a blocked artery in your leg by using a piece of a healthy blood vessel or a synthetic graft. It is only recommended when symptoms are severe and do not respond to conservative therapy. The surgery can significantly restore mobility, reduce pain, and improve your overall quality of life.