Vascular Disease Bypass

What is a bypass for vascular disease?

Vascular disease, particularly arterial blockages, can lead to poor blood flow. As a result, you can develop limb pain and wounds. Bypass procedures reroute blood flow around a blocked artery segment with a graft.

A graft may be a vein from your body or a synthetic material. Providers use synthetic material when they’re unable to use the veins from your body as the graft. The procedure restores blood flow to keep limb tissue alive so you can avoid amputation.

What are the different types of vascular bypass procedures?

There are various types. They’re named according to the artery being bypassed and the arteries receiving the rerouted blood. Some of the most common bypass procedures include:

• Aortobifemoral bypass: The graft starts in the lower part of your aorta, in your abdomen just above your pelvis. It then branches off like an upside-down Y connecting to each leg’s upper femoral artery.
• Femoral-popliteal bypass: The graft starts in your femoral artery at your groin or upper leg and connects to your popliteal artery above or below your knee.
• Femoral-tibial bypass: The graft starts in your femoral artery at your groin or upper leg and connects to the tibial arteries below your knee.

Who is vascular bypass surgery for?

Vascular bypass is for people with severe blockages in the arteries to their lower extremities, including the abdominal aorta. Severe artery blockages are also known as critical limb ischemia, which results from peripheral artery disease (PAD).

Will I need testing before my procedure?

Yes. There are various tests that can help assess your vascular disease, determine which arteries need treatment and plan your bypass procedure. These tests may include ankle-brachial index and vascular ultrasound.

Your provider may perform other tests to check for vascular disease in your heart before proceeding with your vascular bypass procedure. Often, people who have vascular disease in their limbs also have vascular disease in their hearts.

What happens during vascular bypass surgery?

You’ll have your procedure in the hospital. Here’s what to expect:

• An anesthesiologist will give you general anesthesia to keep you comfortable during the procedure.
• Your surgeon will make incisions (cuts) to get to your arteries and veins. The type of bypass and graft will determine the location and extent of the incisions.
• Using tiny stitches, your surgeon hand sews the bypass in place and then closes the incisions.

The procedure generally takes two to six hours depending on the type of bypass performed.

Which veins can serve as a bypass graft?

Healthcare providers often use the saphenous vein, which is just below the skin’s surface in your leg. Other options include arm veins such as the cephalic vein. If your provider needs a larger vein, they may use the femoral vein in your thigh.

If your surgeon can’t use your veins for the bypass graft, then they’ll use a synthetic material instead. Synthetic grafts work well for larger arteries, while your own vein is best for smaller vessel bypasses.

What are the risks and potential complications of the procedure?

Complications can occur during the procedure, during your recovery or years later. People with other medical issues, such as heart disease, kidney failure and/or diabetes, are more likely to experience these issues.

Issues include:

• Bypass graft failure (limited or blocked blood flow through the graft).
• Bleeding at incisions.
• Incision or graft infections.
• Limb nerve damage, numbness or weakness.
• Heart attack.
• Pneumonia.

What happens after the procedure?

You can expect to stay in the hospital for a few days. You may also be on medications that thin your blood (anticoagulants) to prevent blood clots in the graft.

Your provider will expect you to get out of bed and walk around — both in the hospital and at home after surgery. You may need extra help to do so. Some people need physical and/or occupational therapy after the procedure. You’ll be able to gradually return to your daily activities.

What is the outlook for people undergoing vascular bypass surgery?

Limb salvage rates are high with successful bypass graft procedures. However, the procedure doesn’t cure peripheral artery disease (PAD). The grafts can narrow or block up over time.

Grafts are much more likely to fail when people use tobacco, including cigarette smoking. It’s important that you continue to follow up with your vascular surgeon to monitor your bypass.

When should I contact my healthcare provider after having a vascular bypass?

Contact your healthcare provider if you’re experiencing leg issues, such as:

• Pain.
• Cold, pale or blue skin.
• Numbness or tingling sensation.
• Worsening wounds on your legs.

You should also reach out for help if there are other signs of complications, such as:

• Fever.
• Nausea and vomiting.
• Redness and warmth at your incisions.
• Drainage, including pus, from your incisions.

A note from Cleveland Clinic

If you have a diseased or blocked artery to your leg, your healthcare provider might recommend a vascular bypass. This procedure reroutes blood flow around blocked arteries. Most people have good outcomes and high rates of limb salvage, but you need ongoing care to monitor your bypass and manage your vascular disease.

• Kinlay S. Management of Critical Limb Ischemia. Circulation. 2016;9(2). Accessed 10/20/2022.
• Siracuse JJ, Huang ZS, Gill HL, et al. Defining risks and predicting adverse events after lower extremity bypass for critical limb ischemia. Vasc Health Risk Manag. 2014;10:367-374. Accessed 10/20/2022.
• Society for Vascular Surgery. Surgical Bypass. Accessed 10/20/2022.
• Young J, Patel SK. Peripheral Vascular Bypass. [Updated 2021 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 10/20/2022.