Femoropopliteal bypass (fem-pop bypass) for peripheral arterial disease
Femoropopliteal (fem-pop) bypass surgery is used to bypass diseased blood vessels above or below the knee.
To bypass the blocked blood vessel, blood is redirected through either a healthy blood vessel that has been transplanted or a man-made graft material. This vessel or graft is sewn above and below the diseased artery so that blood flows through the new vessel or graft.
Before you have surgery, the doctor will determine what type of material is best suited to bypass the blood vessel. Whenever possible, the surgeon will choose to use an existing piece of vein taken from the same leg. Man-made graft materials (such as polytetrafluoroethyline [PTFE] or Dacron) are more likely to become narrowed again, but they are still effective.
The section of vein or man-made blood vessel graft is sewn onto both the femoral and popliteal arteries so that blood can travel through the new graft vessel and around the existing blockage(s). See a picture of a femoropopliteal (fem-pop) bypass.
General anesthesia or an injection in the spine (epidural) is used for this surgery. General anesthesia will cause you to sleep through the procedure. An epidural prevents pain in the lower part of the body.
What To Expect After Surgery
Because this surgery involves blood vessels that are nearer to the surface, recovery times are shorter than for an aortobifemoral bypass, which requires surgery inside the abdomen.
You will be in the hospital 2 to 4 days after surgery. You can begin sitting up and walking the first day after surgery.
Why It Is Done
Fem-pop bypass is for people who have narrowed or blocked femoral or popliteal arteries, which are near the surface of the legs. Usually the blockage must be causing significant symptoms or be limb-threatening before bypass surgery is considered.
How Well It Works
The bypass remains open in about 66% of people 5 years after surgery when a vein is used. The bypass remains open in 33% to 50% of people 5 years after surgery when a man-made graft is used.2
All surgeries carry risks. There is a risk of infection whenever an incision is required. Other risks include:
- Failed or blocked grafts.
- Heart attack or stroke.
- Leg swelling.
The risk of death because of fem-pop bypass surgery is from 1% to 3%.3
What To Think About
Bypass surgery is preferred for people who have many areas of blockage or a long, continuous blockage.
Angioplasty may be preferred for people who have a small number of short, narrowed areas in the arteries of the leg or pelvis.
- De Vries SO, Hunink MG (1997). Results of aortic bifurcation grafts for aortoiliac occlusive disease: A meta-analysis. Journal of Vascular Surgery, 26(4): 558–569.
- Hirsch AT, et al. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11): e463–e654.
- Creager MA, Loscalzo J (2008). Vascular diseases of the extremities. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 1568–1575. New York: McGraw-Hill Medical.
Last Updated: October 16, 2009