Chapter 85 - Treatment of femoropopliteal disease

Summary

Femoropopliteal bypass is a procedure in which an autogenous vein (typically the greater saphenous vein), prosthetic conduit, or a combination of the two is used to improve lower extremity circulation. Femoropopliteal bypass is most commonly performed for symptomatic atherosclerotic disease of the superficial femoral and/or popliteal artery, including intermittent claudication, rest pain, non-healing ischemic ulcers, or gangrene. Patients with mild intermittent claudication symptoms that are not lifestyle-limiting are seldom treated with bypass, as the natural history of this condition infrequently progresses to threaten the limb. However, a failed bypass can significantly worsen ischemic symptoms and may jeopardize the extremity. Patients with asymptomatic or mild lower extremity peripheral arterial disease are therefore managed with exercise therapy and risk factor reduction therapy aimed at lowering the incidence of stroke and myocardial infarction. Therefore, smoking cessation, control of blood pressure (including salt reduction), and dietary modifications are important steps in this effort. Mild intermittent claudication and asymptomatic or mild peripheral artery disease are not benign conditions; however, their presence is not a good predictor of a future need for major amputation.

Less frequent indications for elective femoropopliteal bypass include femoral or popliteal artery aneurysms and non-atherosclerotic occlusive disease such as popliteal entrapment syndrome or cystic adventitial disease.