Femoral popliteal bypass surgery

Generally, femoral popliteal bypass surgery follows this process:

1. You will need to remove any jewelry or other objects that may interfere with the procedure.

2. You will need to remove your clothing and put on a hospital gown.

3. An IV (intravenous) line will be started in your arm, hand, or collarbone area. More catheters may be put in your neck and wrist to keep track of your heart and blood pressure, and to get blood samples.

4. You will lie on your back on the operating table.

5. If there is too much hair at the surgical site, it may be shaved off.

6. The anesthesiologist will monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. You will be connected to a heart monitor that records the electrical activity of the heart during the procedure.

7. A femoral popliteal bypass may be done under local anesthesia. You will not feel the area to be operated on. You will get medicine in your IV to help you relax before the procedure. But you will likely stay awake, but feel sleepy, during the procedure.

8. Under local anesthesia, you will get oxygen through a tube that fits in your nose.

9. Femoral popliteal bypass may also be done under general anesthesia. You will be asleep. Once you are sedated, your provider will put a breathing tube through your throat into your lungs. You will be connected to a ventilator. It will breathe for you during the surgery.

10. A catheter will be inserted into your bladder to drain urine.

11. You will be given antibiotics through your IV to help prevent infection.

12. The skin over the surgical site will be cleaned.

13. The surgeon will make an incision in the leg. The site of the incision will depend on the section of the arteries to be bypassed. The surgeon will determine whether to use a man-made graft or a vein from the leg to bypass the diseased artery.

14. Once the surgeon has attached the graft onto the diseased artery, a type of X-ray called an arteriogram may be done to make sure that blood flow has been restored to the leg through the new bypass graft.

15. You may get blood pressure medicine through your IV during and after the procedure to keep your blood pressure within a certain range.

16. The incision will be closed. A sterile bandage or dressing will be applied.

Percutaneous transluminal angioplasty (PTA) of the femoral artery

Generally, a PTA of the femoral artery procedure follows this process:

1. You will need to remove any jewelry or other objects that may interfere with the procedure.

2. You will need to remove clothing and put on a hospital gown.

3. You will be asked to empty your bladder before the procedure.

4. An IV (intravenous) line will be started in your hand or arm before the procedure to inject medicine and to give IV fluids, if needed.

5. You will lie on your back on the procedure table.

6. If there is too much hair at the surgical site, it may be shaved off.

7. You will be connected to a heart monitor that tracks the electrical activity of the heart during the procedure. Your provider will watch your heart rate, blood pressure, breathing rate, and oxygen level during the procedure.

8. You will get medicine in your IV before the procedure to help you relax. You will likely stay awake, but feel sleepy, during the procedure.

9. Your provider will check your pulses below the insertion site before and after the procedure.

10. Your provider will inject a local anesthetic into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.

11. Once the local anesthetic has taken effect, your surgeon will insert a sheath, or introducer, into the blood vessel. The catheter will be inserted into the femoral artery through this plastic tube.

12. Your provider will put a special catheter or guide wire into the femoral artery and move it to the site of the blockage using X-ray guidance.

13. The position of the catheter may be confirmed by injecting a small amount of contrast dye into the artery, which may then be seen on a monitor.

14. The surgeon will insert an angioplasty catheter and advance it to the location of the blockage. The surgeon will inflate a balloon at the tip of the catheter. This opens the artery.

15. The surgeon may inflate and deflate the balloon several times to open the artery. In some cases, they may insert a tiny, expandable metal mesh coil (stent) to help keep the artery from narrowing or closing again.

16. Once it has been determined that the artery is opened, the angioplasty catheter will be removed.

17. Your surgeon may close the insertion site with a device that uses collagen to seal the opening in the artery, or with stitches. Your surgeon will determine which method is best for you.

18. A sterile dressing or bandage will be applied.

In the hospital after femoral popliteal bypass

After the procedure, you will be taken to the post anesthesia care unit (PACU) and closely watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room.

Your surgeon will check your pulses below the surgical site often to check blood flow to the limb. They will also check your leg for color (pale or pink), warmth, pain, and movement.

The incision may be sore for several days after the procedure. Take pain relievers as advised by your provider.

You may be on special IV medicine to help your blood pressure and your heart, and to control any problems with bleeding. As you stabilize, your provider will gradually decrease, and then stop, these medicines.

You can return to eating solid foods as you are able to handle them.

When your healthcare team decides you are ready, they will move you to a postsurgical nursing unit. Your recovery will continue. You can gradually increase your activity as you get out of bed and walk around for longer periods.

Arrange for a follow-up visit with your surgeon.

In the hospital after PTA of the femoral artery

You will be taken to the PACU and closely watched after the procedure. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the ICU or your hospital room.

Tell your nurse right away if you feel any chest pain or tightness, or any other pain. Or any feelings of warmth, bleeding, or pain at the insertion site.

The nurse will help you the first time you get up. Move slowly when getting up from the bed so you don’t get dizzy.

You may be given pain medicine for pain or discomfort where the catheter was inserted or from having to lie flat and still for a long period.

You can start to eat solid foods as you can handle them.

Your hospital stay will depend on your condition and the results of your procedure. You will get detailed instructions for your discharge and recovery period.

Arrange for your follow-up visit with your surgeon.

At home after femoral popliteal bypass

Once you are home, it will be important to keep the surgical area clean and dry. Your healthcare provider will tell you how to bathe.

You may be told not to do any strenuous activities. Your provider will tell you when you can return to work and normal activities.

Your provider may want you to keep taking blood thinning medicine after the procedure.

Your provider may do an ultrasound on your leg after surgery to check the new graft.

Call your provider right away if you have any of these:

• Fever or chills

• Increased pain, redness, swelling, or bleeding or other fluid leaking from the leg incision

• Coolness, numbness, or tingling, or other changes in the affected leg

• Chest pain or pressure, nausea or vomiting, heavy sweating, dizziness, or fainting

Your provider may give you other instructions after the procedure.

At home after PTA of the femoral artery

Once at home, check the insertion site for bleeding, unusual pain, swelling, and abnormal color or temperature change at or near the insertion site. A small bruise is normal.

Call your healthcare provider right away if you notice a constant or large amount of blood at the site that can't be contained with a small dressing.

You will be given specific information about how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was. This is normal. The knot should go away over a few weeks.

It’s important to keep the insertion site clean and dry. Your provider will give you specific bathing instructions.

You may be told not to do any strenuous activities. Your provider will tell you when you can return to work and normal activities.

Call your provider right away if you have any of these:

• Fever or chills

• Increased pain, redness, swelling, or bleeding or other fluid leaking from the insertion site

• Coolness, numbness or tingling, or other changes in the affected leg