Overview

An artery carries blood from the heart to the rest of the body. The femoral artery runs down each of your legs, from your groin to your thigh. It is the main artery carrying blood to your leg. 
                        
If there is a blockage in your femoral artery, the blood does not flow (circulate) so easily to your leg. This can cause pain in your calf when you walk, which is called claudication.

Femoral bypass surgery is an operation to make a new route for the blood to flow through. The aims are to:

• avoid (bypass) the blocked area of the artery
• allow you to walk for longer without pain
• help if your circulation is poor, and your foot is painful when you are resting, or at night

When the femoral artery reaches the back of your knee it becomes the popliteal artery. This runs into the distal arteries below the calf and into the foot. The surgery you have might be called femoral popliteal bypass surgery, or femoral distal bypass surgery. The type of surgery you have will depend on where in your leg the artery is blocked. 

Risks of femoral bypass surgery

As with any major operation, there is a risk of you having a medical complication. Your doctor explains all the possible 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: 

• Blockage in the graft (graft thrombosis) leading to lack of blood supply to your legs, which may need more treatment to restore the blood flow. A graft is a piece of another blood vessel from somewhere else in your body.
• 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 prcoedure, 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.

Preparing for femoral bypass surgery

There are a number of ways you can improve your health before your surgery. 

Smoking

If you are a smoker, the most important thing you can do to help yourself is to give up smoking. This will also help to protect all of your arteries, making it less likely that you will have heart attacks or strokes.

Giving up is not easy but there is a smoking cessation service and support groups that can help. Your vascular specialist nurse or GP practice nurse can advise you about these. If you would like to stop smoking, please speak to your nurse. Or call our stop smoking service phone: 020 7188 0995, or call the NHS Smoking Helpline phone: 0300 123 1044.

Activity

Gentle exercise, such as walking and cycling, is recommended to help improve your overall level of fitness. Exercise helps your body to produce healthy cholesterol and this helps to protect your arteries against bad cholesterol. Exercising may be difficult if you have claudication, however it is important to keep as active as you can.

Blood pressure

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

Diabetes

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

Blood cholesterol (fatty substance in your blood) levels

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 to help lower your cholesterol (for example, a statin), and low dose aspirin to help prevent blood clots from forming.

Weight

There are increased risks when having an anaesthetic and the operation if you are overweight, so losing weight and having a healthy diet will help reduce these risks. Your GP may be able to refer you to a dietitian if you need help.

Having surgery

To do a femoral bypass, the surgeon needs to get to the artery above and below where it is blocked. A cut (incision) is made in your groin, and a second cut is made below the blocked area of the artery. This might be just above or below your knee, on the inside of your leg. Or, it might be lower in the calf, and on the outside of the leg.

This operation is done using a piece of another blood vessel from somewhere else in your body (a graft) to create the bypass. Sometimes we use an artificial blood vessel made of plastic. If the graft is one of your own veins, this might be taken from your other leg, or an arm. The surgeon will talk to you about where it is best to take a vein from. If none of your veins are suitable, you might have an artificial graft.

The graft is joined to the artery above the blockage, and to the artery below the blockage. This is done using very fine stitches, which do not get removed.

The cuts are closed with stitches that are not dissolvable. We will arrange for your GP's practice nurse, or a district nurse, to remove these after your surgery.       

Pain during 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.

If you do not have an epidural, you might be given pain medicine through a drip into a vein in your arm or hand. The machine used allows you to control the amount of medicine you have (the dose) by pressing a button. The machine will not let you have more than a safe dose of medicine.

After femoral bypass surgery

You will wake up in the recovery area, where you will be monitored until you are ready to be moved to a 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.

If you have had an epidural, this will be checked by the pain team and removed when you no longer need it. You might have had a thin tube (catheter) put in during surgery to help you pee. This will be removed when you are able to go to the toilet.

You can expect to be in hospital for 5 to 7 days. You might have bruising around the area of your surgery, and your leg might be swollen. The swelling can take a few months to go down.  

You will see a physiotherapist while you are in hospital. They will check your mobility and give you exercises to help strengthen your legs. They will also check if you need any walking aids.

You will be given antiplatelet medicine (such as, aspirin or clopidogrel), which makes your blood less ‘sticky’. You might also be given an anticoagulant, to lower the risk of your bypass becoming blocked. This is called a direct oral (by mouth) anticoagulant (DOAC). Your surgeon will decide if you need this medicine. You will also be given a statin if you do not already take one, to help protect your arteries. You will probably need to take these medicines long term.

Leaving hospital

If you had stitches that are not dissolvable put in during surgery, these will need removing. We will arrange for your GP’s practice nurse, or a district nurse, to do this.

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

You should be able to slowly go back to your normal activities.

You should not lift heavy objects, or do too much stretching at first.

Follow-up appointment

You will be given an appointment to see your surgeon 6 to 8 weeks after surgery. We will try to make sure this is at your local hospital, but this is not always possible. To make sure everyone you meet always has the most up-to-date information about your health, we might share information about you between hospitals.