The femoral artery starts in the lower abdomen and runs down into the thigh. This artery delivers blood to your legs. When the femoral artery reaches the back of the knee it becomes the popliteal artery. When there is a blockage in this artery, the circulation of blood to your leg is reduced which may cause pain in your calf when you walk, and is known as intermittent claudication.
This operation should allow you to walk further without pain. This surgery is also recommended when the circulation is so poor that your foot is painful at rest or at night. Another symptom indicating a possible blockage in the artery may be leg ulcers or black areas of dead skin. In such cases, this operation can be used to prevent the amputation of your leg below or above the knee.
A femoral popliteal bypass is an operation to bypass the blocked portion of the artery in the leg using a piece of another blood vessel.
Before your operation
Before bypass surgery, there are a number of tests that need to be done. These are of two types: those to assess your general fitness and those to assess your suitability for different types of bypass surgery.
Tests of fitness and suitability are normally done before a decision to operate is made. They normally include:
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Blood tests
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An ECG
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An CT scan of the blocked artery
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Ultrasound assessment of the vein which will normally be used to perform the bypass
These immediate pre-operative tests are usually completed at a pre-admission visit to the hospital a few days before your operation. They may sometimes be done when you are admitted for the operation. Sometimes, the course of the vein to be used for the bypass will be marked in your leg with an indelible pen. This marking is done with the assistance of ultrasound.
Coming into hospital
Please bring with you all the medications that you are currently taking. You will be admitted to your bed by one of the nurses who will also note down your personal details in your nursing record. You will be visited by the Surgeon who will be performing your operation and also the doctor who will give you the anaesthetic. If you have any questions regarding the operation please ask the doctors.
The Operation
The blocked artery must be exposed both above and below the blockage. A vertical incision about 10cm (4inches) long is made in the groin to expose the common femoral artery. This is the main artery supplying the leg, and is usually the point from which the bypass starts. A second incision of similar length is made to expose the artery below the blockage. This may be just above or below the knee and is on the inner side of the leg. Occasionally, the incision is lower in the calf, and may then be on either side.
The tube used to perform the bypass will normally be the principal skin vein of the leg. It is called the long saphenous vein and it runs up the inner side of the leg from ankle to groin. Helpfully, the vein lies in the line of the incisions used to expose the artery. Sometimes the vein can be removed with the addition of another small incision about 5cm long at mid thigh level. Sometimes the two main incisions are joined to make one long incision. If the long saphenous vein is unavailable, its counterpart in the other leg or a vein from the arm may be used instead.
If no vein is suitable, an artificial tube is used. This is made of plastic and may be one of several types. The bypass tube is joined to the artery at groin level and again to the artery below with very fine permanent stitches. The graft will sometimes lie deep within the leg, and sometimes just beneath the skin. If it is beneath the skin (in situ vein bypass) the pulse in it can easily be felt. At the end of the operation, the incisions are all closed, either with dissolving stitches, which do not need to be removed, or with a non-dissolving stitch or metal clips which will normally be removed after about ten days.
