77 - Femoropopliteal bypass grafting

Summary

Femoropopliteal bypass is a procedure in which autogenous vein (typically the greater saphenous vein), a prosthetic conduit, or a combination of the two is used to improve the circulation of the lower extremity. This is most commonly performed for atherosclerotic disease of the superficial femoral and/or popliteal artery, though it is occasionally done to treat a popliteal aneurysm.

Indications for femoropopliteal bypass performed for chronic arterial insufficiency typically include severe, disabling short distance calf claudication, rest pain, ischemic non-healing ulcers, or gangrene. Not uncommonly, atherosclerotic obstructions of the superficial femoral artery can be asymptomatic and such lesions rarely if ever require treatment. Mild to moderate claudication symptoms are seldom treated with bypass, as the natural history of this condition infrequently progresses to threaten the limb and a failed bypass can significantly worsen the ischemic symptoms and may jeopardize the extremity.

In addition to a thorough history and physical examination, preoperative assessment typically includes Doppler measurement of the ankle-brachial index and imaging with contrast arteriography. Alternate imaging modalities such as ultrasound or MRA are occasionally performed, especially if the patient has renal insufficiency. The surgeon evaluates the imaging studies to verify that there are no significant lesions proximal to the femoral artery or distal to the popliteal artery that would compromise the success of the bypass. Prior to operative intervention, attention should be directed toward assessment of the heart, as a significant number of patients with lower extremity arterial occlusive disease have concomitant coronary artery disease.