What is a Femoral-Tibial Bypass?

A femoral-tibial bypass is a surgical procedure that redirects blood around blocked arteries in the leg. There are several arteries in the leg that can become diseased and narrowed by fatty deposits called plaque. These blockages impede the flow of oxygen-rich blood to the lower leg and foot, causing pain, coldness, and difficulty walking. If left untreated, the patient can develop gangrene and require amputation of part of the leg or foot. A femoral-tibial bypass can be a very effective way of reducing the pain associated with blocked arteries and keeping the limb.

The arteries that may be involved in a femoral-tibial bypass include the femoral artery, the popliteal artery, and the tibial arteries. The femoral artery is a superficial artery that begins in the groin and runs down the upper leg. When it reaches behind the knee, it becomes the popliteal artery, which runs into the lower leg and splits into the posterior tibial artery, peroneal artery, and anterior tibial artery. These three smaller arteries feed blood to the lower leg, ankle, and foot. Blockages in any of these blood vessels may require a femoral-tibial bypass.

Prior to the procedure, the patient is anesthetized either with general anesthesia, which renders the patient unconscious for the entire surgery, or an epidural, which numbs the lower body. The surgeon will then sew a graft into the artery to redirect blood around the diseased vessel. The graft is usually made from veins in the body, typically harvested from the saphenous vein of the leg, but it can also be made of man-made material. Man-made grafts are only used when there are no other available blood vessels because they have a much lower success rate.

Though it is a major surgery, a femoral-tibial bypass does not require as lengthy a hospital stay or recovery time as bypass surgeries that require work on deeper blood vessels, such as the aortobifemoral bypass. The patient can expect to remain in the hospital for three to five days and stay in bed for one to two days following the procedure. The full recovery takes several weeks. Risks of femoral-tibial bypass include bleeding, infection, graft failure, swelling, heart attack, or stroke.

Often, when people have narrowing in one of the superficial arteries in the leg, there are blockages elsewhere in the leg and in the body. These patients often suffer from peripheral artery disease (PAD), which causes hardening in the blood vessels of the legs, and atherosclerosis, a more general condition marked by the accumulation of fats along the arterial walls. Smoking, history of vascular problems, high cholesterol, diabetes, high blood pressure, and obesity can raise the risk of developing these diseases.