Aortobifemoral Bypass

What is aortobifemoral bypass?

Aortobifemoral bypass is a form of vascular disease bypass surgery that surgeons perform in your abdomen (belly). It’s an open surgery that creates a new route (bypass) for blood to flow around narrowed or blocked portions of your arteries. This improves blood flow to your legs.

A vascular surgeon inserts an artificial blood vessel (graft) into your belly in the area of the diseased arteries. The graft typically consists of polyester. “Aortobifemoral” refers to the arteries that connect with the graft:

• “Aorto” refers to your aorta, which is the largest artery in your body. It leaves your heart at your aortic valve and extends down through your chest and belly.
• “Femoral” refers to your femoral arteries, which begin near your groin and travel down each thigh to the back of your knee.
• “Bi” refers to the fact that the graft connects with both of your femoral arteries (you have one in each leg).

The graft has the shape of an upside-down letter “Y.” The top of the graft connects with the lower portion of your aorta in your belly. Each stem of the Y connects with each of your femoral arteries.

Healthcare providers may recommend this surgery if plaque buildup in major arteries in your belly or pelvis causes severe symptoms or places you at high risk for complications.

An aortobifemoral bypass graft reroutes blood flow from your abdominal aorta to your femoral arteries.

What does this surgery treat?

Aortobifemoral bypass surgery treats severe aortoiliac occlusive disease. With this condition, plaque gradually builds up in major arteries in your belly and pelvis. These are your:

• Abdominal aorta, or the lower part of your aorta that extends straight down through your belly.
• Iliac arteries, or the arteries that begin at the base of your abdominal aorta (near your belly button). Your two external iliac arteries (one on each side of your body) travel toward your groin, where they become your femoral arteries.

Extensive plaque buildup can narrow or block blood flow in your abdominal aorta and iliac arteries. As a result, your lower body (including your legs, feet and organs in your pelvis) can’t receive enough oxygen-rich blood. Severe narrowing or blockages can lead to complications, including:

• Pain in your legs when you walk (intermittent claudication).
• Severe leg pain at rest.
• Gangrene.
• Amputation.

Although bypass surgery can’t cure aortoiliac occlusive disease, it can ease your symptoms by delivering blood flow to your legs. This will decrease the occurrence of the complications mentioned above.

How serious is aortobifemoral bypass?

Aortobifemoral bypass is an open surgery that requires a large incision in your belly. Healthcare providers consider this major surgery.

A minimally-invasive alternative is aortoiliac stenting with bifurcation reconstruction (AISBR). This is a form of endovascular surgery that places a stent inside your clogged arteries to open them up and improve blood flow. Some research shows that AISBR may have a lower risk of surgical complications and a shorter hospital stay than open surgery.

Your healthcare provider will determine whether open surgery or endovascular surgery is right for you. Traditionally, surgeons would use AISBR for people with a higher surgical risk. But thanks to advances in technology, surgeons today are using AISBR much more often instead of open surgery.

You may need open surgery if you’re not a candidate for endovascular surgery, or if you’ve had endovascular surgery in the past and it wasn’t successful for you. Talk to your provider about available options for you and the pros and cons of each in your specific situation.

How should I prepare?

Your surgical care team will tell you how to prepare for your surgery. In general, it’s important to:

• Quit smoking, and avoid all tobacco products. Avoiding tobacco products for at least three to four weeks prior to your surgery can help give you a good outcome. You should continue to avoid tobacco products after your surgery to support the health of your heart and blood vessels, and lower your risk of cardiovascular disease.
• Talk to your provider about your medications. You may need to adjust your medication schedule prior to your surgery. Your provider may also ask you to take certain medications beforehand.
• Fast after midnight. Your provider will give you instructions on fasting, or avoiding foods and drinks the night before your surgery.

You may need to visit your provider for various tests, including:

• Ankle-brachial index.
• Vascular ultrasound.
• Imaging tests that check the health of your heart and coronary arteries.

What happens during aortobifemoral bypass surgery?

To reroute blood flow in your belly, your surgical team will perform the following steps:

1. Give you general anesthesia to put you into a deep sleep.
2. Make one long incision (cut) in your belly (laparotomy). The incision allows your surgeon to access your aorta.
3. Make an incision at the top of each of your thighs to access your femoral arteries.
4. Insert your graft. Your surgeon will sew the top of the graft to your aorta, above the blocked or narrowed part. They’ll sew the bottom two portions of the graft to your femoral arteries, below the blocked or narrowed part.
5. Close the incisions in your belly and upper thighs with staples or stitches.

How long does aortobifemoral bypass surgery take?

You can expect the surgery to take anywhere from two to six hours.

What happens after this procedure?

You’ll spend four to seven days in the hospital recovering. During this time, your care team will:

• Closely monitor you for signs of complications, including infection.
• Check blood flow in your legs.
• Help you gradually walk around more each day.
• Give you pain medication as needed.

What are the benefits of this surgery?

Aortobifemoral bypass surgery can help ease your symptoms and lower your risk of complications from aortoiliac occlusive disease. This surgery gives you the following benefits after your recovery:

• You won’t have any more leg pain while at rest.
• You’ll have less leg pain related to blood flow when walking, allowing you to walk longer distances than before.
• You should have the ability to heal leg and foot wounds to prevent gangrene.

How successful is this surgery?

About 80% to 95% of surgeries successfully improve blood flow for at least five years. The success rate at 10 years ranges from 74% to 86%.

What are the risks or complications?

Possible complications of aortobifemoral bypass surgery include:

• Heart attack.
• Stroke.
• Bleeding.
• Blood clots.
• Infection in your surgical wound.
• Infection in the graft.
• Kidney failure.
• Lung failure.

It’s important to discuss all possible risks with your surgical care team prior to your surgery.

What is the recovery time?

Full recovery may take two to three months. But you should be able to return to some of your normal activities after about four to six weeks.

You may have incision pain for the first few weeks after your surgery. Your provider will prescribe pain medication as needed to help you feel better. Be sure to:

• Take your pain medication and all other medications exactly as your provider prescribes them. Ask if you’re unsure about any aspect of your medication schedule.
• Care for your incisions according to your provider’s instructions.
• Exercise according to your provider’s guidance. For example, short walks — a bit longer each time — can help support your recovery. But don’t do anything more than your provider recommends.

When can I go back to my usual routine?

Your care team will tell you when it’s safe for you to:

• Drive.
• Return to work.
• Engage in strenuous exercise (like running, cycling or lifting weights).
• Lift heavy objects.
• Take a bath.
• Have sex.

In general, it’s important to take it slow in the weeks following your surgery to give your body time to recover.

When should I call my healthcare provider?

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

• Fever.
• Nausea and vomiting.
• Pain or a feeling of warmth around any of your incisions.
• Discoloration (skin that looks red, brown, purple or white) around any of your incisions.
• Redness or swelling in your groin area or leg.
• Drainage from your incisions.
• Pain, numbness or tingling in your leg.
• Skin ulcers that get worse.
• Cold, pale or blue skin anywhere on your leg or foot.

When should I seek emergency care?

Call 911 or your local emergency number right away if you have symptoms of a heart attack or stroke.

Symptoms of a heart attack include:

• Chest pain or discomfort.
• Shortness of breath.
• Nausea or stomach discomfort that may feel like indigestion.
• Heart palpitations.
• Fatigue.
• Anxiety or a feeling of “impending doom.”
• Dizziness or fainting (passing out).
• Sweating.

Symptoms of a stroke include:

• Weakness or paralysis on one side of your body.
• Trouble speaking or loss of speaking ability (aphasia).
• Slurred or garbled speech.
• Loss of muscle control on one side of your face.
• Sudden total or partial loss of one or more senses (such as vision or hearing).
• Blurred or double vision.

A note from Cleveland Clinic

Planning for any major surgery can feel stressful and overwhelming. Your surgical team understands this, and they’ll help you feel more comfortable as you approach your surgery day. Don’t hesitate to ask any questions or share your concerns. Be sure to get all the information you need to feel ready for your surgery and prepared to take care of yourself at home as you recover.