Surgical Bypass – Peripheral

When Is a Surgical Bypass Needed?

Usually, other therapy is tried first. If these fail and an alternative treatment such as a balloon angioplasty and stenting is not suitable, then tests may be performed to assess the possibilities of a surgical bypass.

A surgical bypass may help you if you have peripheral arterial disease (PAD) and symptoms such as:

  • Leg muscle pain while walking
  • Pain at night, especially in the feet
  • Feet and leg sores that won’t heal
  • Dead tissue



In the Leg

A fem-pop bypass uses a natural or synthetic graft to create the detour around the blockage beginning at your groin/thigh crease and ending at the inner knee, or sometimes the calf or foot.

An incision, about 4–8 inches long, is made at the groin crease and again at the end point. If your own vein is used to create the graft, other small incisions may be made on the inner portion of the thigh. Otherwise, a synthetic tube made of fabric or plastic will be used. The graft is sewn to the artery at both ends with fine stitches.

Surgery can take 1.5 to 6 hours.

In the Abdomen

An aortic bypass uses a synthetic graft made of fabric or plastic, and a vertical midline abdominal incision is made.

With the help of the graft, a surgical bypass routes blood flow around an area of blockage caused by PAD. The surgery does not cure the disease or remove the blockage, but is used as a road detour.

Surgery can take 3 to 4 hours.




What Are the Possible Risks of the Procedure?

The bypass graft can become blocked soon after surgery or years later. This is sometimes remedied by another surgery or catheter procedure, and sometimes by a new bypass.

Other possible complications after surgery include:

  • Heart attack
  • Wound infections
  • Bladder or other infections
  • Pneumonia


Before the Procedure


Taking Medication

Carefully follow instructions given by your doctor about medications the day before and day of surgery.

How to Prepare

  • Stop smoking as soon as possible to lessen the chance of many of the complications
  • Get your vascular surgeon’s approval on the surgery
  • Get any recommended tests done (blood tests, EKG, X-rays, etc.)
  • Follow your normal routine
  • Get plenty of sleep
  • Eat a normal meal the evening before your procedure
  • Do not eat, drink, or chew anything after midnight before your procedure. This includes gum, mints, water, etc.


After the Procedure


What to Expect After the Procedure

If you had an aortic bypass, you will be in the hospital for 5-7 days for monitoring and recuperation. Please note, the bowels often go to sleep for several days, therefore food is reintroduced gradually. To regain strength, some patients may need to go to a rehab facility for a few days after leaving the hospital.

The lifespan of a surgical bypass depends on the health of your arteries, the type of graft used, and other health factors.


How You Will Feel After the Procedure

You’ll have incision pain/discomfort for several days or weeks. This will be treated with pain medication. Typically, there is swelling (around the leg or abdomen) and sometimes drainage. Furthermore, there may be numbness around or drainage from the incision. You’ll get instructions on how to treat these symptoms.

You may also experience:

  • Muscle pain with walking should improve/resolve and wounds should heal.
  • You may lose your appetite for a while and lose some weight.

Activities Guideline

When you go home, it is wise (possibly required) to have someone stay with you for a few days.

You will be able to ride in a car and walk up steps, but you will need time to recuperate before driving or doing heavy work. This will depend on your condition and type of bypass.



To monitor the bypass graft, arrange follow-up visits with your vascular surgeon for ultrasound tests.

Occasionally, additional procedures are needed to keep the bypass functioning properly.