(Femoropopliteal Bypass-Open, PTA, Balloon Angioplasty)
Femoral popliteal (also called femoropopliteal) bypass surgery is a surgical procedure that may be used to treat severe blockage due to plaque in the femoral artery. A newer, minimally-invasive procedure is percutaneous transluminal angioplasty (PTA) of the femoral arteries.
The femoral and popliteal arteries are located in the legs. Their function is to supply oxygen-rich blood and nutrients to the legs. Femoral and popliteal arteries are called peripheral arteries because of their location away from the center of the body. Disease of the arteries of the limbs (particularly the legs and feet) is referred to as peripheral arterial disease (PAD).
Peripheral arterial disease (PAD) is generally associated with blocked arteries of the legs. The blockage most often is the result of a chronic buildup of hard fatty material (atherosclerosis) into the inside lining of the arterial wall of the legs. This ultimately narrows and blocks the flow of blood which carries oxygen and nutrients to the limb. The femoral and popliteal arteries are the major arterial blood supply to the lower extremities and are a common location for atherosclerotic disease to develop.
The presence of atherosclerosis in the leg arteries is a strong indicator that there is also atherosclerosis in the arteries of the heart and brain, because atherosclerosis is a widespread disease of the arteries. Atherosclerosis of the leg arteries may cause a blockage, obstructing blood flow, and potentially result in pain in the leg(s), ulcers or wounds that do not heal, and/or the need for amputation (surgical removal) of a foot or leg. Therefore, PAD has two major complications associated with its presence: limb complications (nonhealing wounds, ulcers, gangrene, loss of a limb) and risk for stroke and/or heart attack.
Peripheral arterial disease caused by atherosclerosis may be present with symptoms or without symptoms. The presence of symptoms may depend on the degree to which blood flow to the leg muscles has been decreased. Symptoms may range from mild to moderate to severe.
The most common symptom of peripheral arterial disease is called intermittent claudication. Claudication refers to limping because of pain in the thigh, calf, and/or buttocks that occurs when walking. The pain or discomfort of claudication starts with walking or exercise and stops with rest. Walking or exercise increases the demand for oxygen and nutrients needed for the leg muscles to do work. Decreased blood flow through the affected artery of the leg(s) due to narrowing or occlusion (blockage) decreases the amount of oxygen and nutrients to the muscles and may result in pain. This symptom is reproducible (the same exercise, at the same pace, and the same distance, will reproduce the same symptom), which is helpful in diagnosing the condition.
Just as chest pain or angina of the heart can signal a heart attack, intermittent claudication may be considered as "angina of the legs" and may indicate lack of blood flow to the legs. Other symptoms of peripheral arterial disease may include, but are not limited to, the following:
The most severe symptom of peripheral arterial disease caused by atherosclerosis is called critical limb ischemia (lack of oxygen to the limb/leg at rest). Critical limb ischemia (CLI) is defined as pain in the leg(s) while at rest, or "rest pain." CLI is also associated with the breakdown of tissues (muscle or skin) in the form of ulcers or gangrene in the limb, which may occur because blood flow to the limb is so decreased that the basic needs of the limb for oxygen and nutrients are not being met. Critical limb ischemia may include some or all of the symptoms of peripheral arterial disease as well.
Because peripheral arterial disease is associated with the two other major atherosclerotic conditions, coronary artery disease (heart disease) and cerebrovascular disease (stroke), treatment may range from management of risk factors to surgical procedures. The same risk factors that may contribute to a heart attack or stroke are the same for peripheral arterial disease. These include, but are not limited to, the following:
There are two procedures used to treat PAD of the femoral arteries. The standard surgical procedure is femoral popliteal bypass surgery (fem-pop bypass), while a newer minimally invasive endovascular intervention is called percutaneous transluminal angioplasty (PTA) of the femoral artery.
Reasons a femoral popliteal bypass surgery or PTA of the femoral artery may be performed include, but are not limited to, the following:
Not all peripheral arterial disease can be treated with PTA. Your doctor will decide the best treatment of your PAD based on your individual circumstances.
There may be other reasons for your doctor to recommend femoral popliteal bypass surgery or PTA.
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or latex should notify their doctor.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Femoral popliteal bypass surgery and percutaneous transluminal angioplasty of the femoral artery require a stay in the hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, femoral popliteal bypass surgery follows this process:
Generally, a PTA of the femoral artery procedure follows this process:
After the procedure you will be taken to the recovery room for observation. 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 pulses below the surgical site will be checked frequently to assist in monitoring blood flow to the limb. Your leg will also be monitored for color (pale or pink), warmth (coolness), sensations of pain, and movement.
The surgical incision may be tender or sore for several days after the procedure. Take a pain reliever for soreness as recommended by your doctor.
You may be on special IV medications to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these medications will be gradually decreased and discontinued as your condition allows.
Your diet will be advanced to solid foods as tolerated.
When your doctor determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue to progress. Your activity will be gradually increased as you get out of bed and walk around for longer periods of time.
Arrangements will be made for a follow-up visit with your doctor.
After the procedure you will be taken to the recovery room for observation. 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.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
The nurse will assist you the first time you get up. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bed rest.
You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
Your diet will be advanced to solid foods as tolerated.
Your hospital stay will depend on your condition and the results of your procedure. You will receive detailed instructions for your discharge and recovery period.
Arrangements will be made for a follow-up visit with your doctor.
Once you are home, it will be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.
Your doctor may want you to continue on specific medications, such as aspirin or clopidogrel (Plavix), after the procedure.
Your doctor may perform ultrasound examination(s) on your leg after surgery to monitor the new graft.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.
If your doctor used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and 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 gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your doctor with any questions or concerns you may have regarding your condition.
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National Cholesterol Education Program
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)
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