Overview

There are 2 types of crossover bypass grafts:

• femoro-femoral
• ilio-femoral

The iliac arteries in your pelvis supply blood to your legs. Unfortunately, some people get narrowing or blockages in their iliac arteries. Gradually the leg muscles become painful. The pain is normally worse when exercising, but it can get so bad that it happens at night. In severe cases it can even cause gangrene.

When only an iliac artery is blocked, we can join the femoral artery at the top of your affected leg, and the one from your good side, using a graft.

Benefits of having a femoro-femoral crossover bypass

This operation should allow you to walk further and without pain. This surgery is also recommended when the circulation is so poor that your foot is painful when you’re resting or at night.

Risks of a femoro-femoral crossover bypass

Bypass blockage

The main possible complication of this operation is blood clotting within the bypass, causing a blockage. If this happens, it usually needs more surgery to clear the bypass.

Graft infection

Very rarely (about 1 in 500 people), the artificial graft gets infected. This is a serious complication and usually means we have to remove the graft.

As with any major surgery, there is a risk of you having a medical complication. All potential risks will be explained and discussed with you when the consultant asks you to sign the consent form before the operation.

Read more about having an anaesthetic.

Giving your permission (consent)

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

Read more about our consent process.

Preparing for surgery

You will come to hospital for your pre-assessment appointment. We will tell you how to prepare, and review your regular medicines.

If you are taking any antiplatelet medicines (such as aspirin or clopidogrel), or any blood-thinning medicines (such as warfarin), you might need to stop them temporarily before the procedure.

If you are taking any medicines for diabetes (for example metformin) or using insulin, these might also need to be stopped temporarily, or the dose (amount) changed, near the time of the procedure. You will be given full information on any changes that you need to make to your medicines at the pre-assessment appointment. Please ask us if you have any questions.

You must fast (not eat or drink anything except water) for 6 hours before surgery. We will give you clear instructions on exactly when to start fasting. It is important to follow these instructions. If there is food or liquid in your stomach during your operation, it could come up to the back of your throat and damage your lungs.

Please continue to take your regular medicines with a sip of water before 6am on the morning of the procedure, unless you have been told otherwise.

During the operation

You will usually have 2 cuts (incisions). This is usually 1 in each groin, or, 1 in the groin and another in the lower part of your tummy (abdomen). A plastic replacement artery will be put in, to allow the blood to bypass the blocked artery. The artery going to your good leg will supply both legs with blood.

The wounds are closed with either stitches that dissolve, or stitches or clips that will need to be removed.

Pain

During your surgery

Your operation will be done using a general anaesthetic or an epidural.

A general anaesthetic gives a state of controlled unconsciousness. It is like being asleep and you do not feel any pain.

An epidural involves having a small tube put into your back, so that we can give you medicine which numbs your legs. The epidural might also be used to control your pain after the operation.

After your surgery

The nurses will try to keep you free of pain. This might be by:

• giving you continuous painkillers using the epidural
• a machine that delivers pain relief through a drip into your arm or hand (called patient-controlled analgesia or PCA)
• oral (by mouth) painkillers

You will probably have some bruising around the area operated on.

After the procedure

After surgery you will be taken to the recovery room where you’ll be monitored until you are awake enough to move to Sarah Swift ward or another cardiac (heart) ward.

You will be given fluids through a drip into a vein until you feel well enough to sit up to eat and drink normally.

Within 2 days of having the epidural, your drip (which is inserted during surgery to make sure you get enough fluids) and your catheter (thin tube that empties your bladder) will be removed.

You will gradually become more mobile until you are well enough to leave hospital. You should expect to be in hospital for 4 or 5 days.

It is common for legs to be swollen after this surgery, and this can take a few months to go down. It normally goes completely, but occasionally some swelling is permanent. You can reduce the swelling by elevating (raising) your legs when you are sitting down.

You will be visited by a physiotherapist in hospital after your operation. They will help you with your breathing to prevent you developing a chest infection, and will help to get you walking again.

You will be given aspirin, to thin your blood and reduce the risk of your bypass becoming blocked. You will probably need to continue to take aspirin long term.

After you leave hospital

We will arrange for your GP’s practice nurse or a district nurse to remove any stitches or clips.

Your dressing will usually be removed before you leave hospital. If you still need a dressing when you leave, we will arrange for your GP’s practice nurse or a district nurse to change it regularly, and check the wound. It is OK to have a shower.

You should be able to gradually resume normal activities as soon as you feel well enough. Avoid heavy lifting and frequent stretching at first.

How to help yourself get well again

Smoking

If you are a smoker, the most important thing you can do to help yourself is to give up smoking. Stopping smoking will also help to protect all of your arteries, making it less likely that you will suffer from heart attacks or strokes. If you would like to give up smoking, please speak to your nurse or contact our Stop Smoking service, phone 020 7188 0995, or the NHS Smoking Helpline, phone 0300 123 1044.

Activity

Gentle exercise, such as walking or cycling, is recommended to help improve your overall fitness. Exercise helps your body to produce healthy cholesterol, and this helps to protect your arteries against bad cholesterol.

Blood pressure

It is important to have your blood pressure checked regularly, at least every 6 months. If you have been prescribed medicine for high blood pressure, you must make sure that you take it following the instructions given.

Diabetes

If you have diabetes, it is important that your blood sugar levels are well controlled.

Cholesterol (fatty substance in your blood)

You should eat a healthy, balanced diet and try to reduce any excess weight. It is important to reduce the level of cholesterol in your blood. Your vascular nurse can refer you to a dietitian if needed. You might be prescribed medicine (such as statins), and a low dose of aspirin to help lower your cholesterol level and prevent blood clots from forming.