Overview

Arteries carry blood away from your heart to the rest of your body. When the main arteries in your stomach (the aorta and iliac arteries) are significantly narrowed, this affects the blood supply to your legs.

An aorto-bifemoral and an axillo-bifemoral bypass are 2 operations that can treat this condition.

Aorto-bifemoral bypass

The aorto-bifemoral operation is used to avoid or go past (bypass) the blocked or narrowed main blood vessels (aorta and iliac arteries). A synthetic, fabric graft is used to recreate the normal shape of your aorta and iliac arteries. This restores circulation and relieves symptoms. A graft is a piece of another blood vessel from somewhere else in your body.

The procedure involves making a cut (incision) in the tummy (abdomen) to reach the aorta. It also involves a cut in each groin to reach the femoral arteries (the arteries below the blockage). The fabric tube graft, which is shaped like a pair of trousers, is tunnelled under the skin and then sewn onto the existing blood vessels, creating the bypass.

The wounds are closed either with stitches under the skin (subcutaneous) that dissolve over time, or with metal clips that will need to be removed about 10 days after the surgery.

Axillo-bifemoral bypass

The axillo-bifemoral operation is also used to bypass blocked or narrowed arteries. A synthetic, fabric graft is sewn into your axillary artery (left or right). The axillary artery is located under the collar bone, in front of the shoulder, and connected to your femoral arteries, located in the top of your legs. This bypasses the blocked or narrowed arteries and restores blood flow to your legs. 

The procedure involves a cut on your chest, just by your shoulder, and into both of your groins. The graft is tunnelled under the skin, down the side of your chest and tummy to your groin. As the graft is tunnelled under the skin, it may be easily visible or felt in thin patients. 

The wounds are closed either with stitches under the skin that dissolve, or with metal clips that will need to be removed about 10 days after the surgery. 

The axillo-bifemoral operation is used in people who are considered high risk for aorto-bifemoral surgery. It creates less stress on the heart and it avoids making a cut in your tummy. However, an axillo-bifemoral operation is more likely to have complications, such as blockages and infection. This is because the graft used is narrower and is not as well buried in the tissues. 

Benefits of having an aorto or axillo-bifemoral bypass

Both operations are performed to help to improve your symptoms by increasing the blood supply to your legs. Some of the symptoms you might have include:

• muscle aching related to exercise, which is known as claudication
• a constant burning pain in your feet, which is known as rest pain or critical limb ischaemia
• ulcers or gangrene (when tissues in your body die) due to lack of blood supply 

Restoring the blood flow should ease the pain and allow ulcers and areas of damaged skin to heal.

Risks of having an aorto or axillo-bifemoral bypass

As with any major operation, there is a risk of you having a medical complication. Your doctor will go through all the risks with you before you sign your consent form. The more common surgical risks include: 

• blood clot in the leg (deep vein thrombosis)
• heart attack
• acute kidney injury (AKI)
• collection of blood around the wound site (wound haematomas)
• chest infections

The risk of these will depend on your age, general fitness and any other medical problems you may have, such as heart disease. 

Complications specific to this procedure include: 

• Graft thrombosis (blockage in the graft) leading to lack of blood supply to your legs, which may require further intervention to restore the blood flow. 
• Limb loss, if the blood supply cannot be restored.
• Graft infection, which may require replacement of the graft or long-term antibiotic treatment.
• Bleeding from where the graft has been sewn onto the artery, which may require further surgery.

These complications are rare and should be discussed with your consultant. 

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure, you will be asked to sign a consent form. This states that you understand what is involved and agree to have the treatment. 

Read more about our consent process.

Other treatment options

We usually recommend a bypass if the blockage or narrowing in your aorta or iliac arteries is severe and your blood supply is severely compromised. 

The only alternative is symptom control, such as pain relief and any wound management, if appropriate.

You may be offered a major amputation for pain control or if your skin is very badly damaged.