Lower Extremity Bypass

What to expect with your surgical procedure

Lower extremity bypass grafting includes procedures such as femoral (groin) to popliteal (behind the knee), femoral-tibial (calf) or femoral-distal (closer to the foot) bypass grafting. The operation usually takes between 2-3 hours if a vein from your own body is used for the graft. Using a synthetic graft takes less time but is only used when a vein is not available or when vein is not the best choice for the bypass.

Recovering from the procedure

Usually you will be discharged from the hospital in 3 days with synthetic graft, or 5 days with vein graft. Pain should be adequately controlled in the hospital with IV, epidural and oral medication. You will be given a prescription for pain pills when you leave the hospital. It is not uncommon to have some redness and swelling in the area where you had your surgery. The redness should gradually fade, and the swelling should be kept to a minimum by resting in between activities with the affected leg(s) elevated above the level of your heart (in a recliner, or on a couch or bed). You will have no real lifting restrictions, although you should not carry anything too heavy while your wounds are healing. You should walk regularly and gradually increase activity, but know that until you are completely healed, increased activity will increase swelling. The more you can elevate the affected leg(s) between activities, the less swelling you will have. Elevation will make it less likely that you will suffer from possible wound complications such as seroma (the collection of lymph fluid that can cause good sized lumps under the skin near incision lines), fluid drainage, and infection. Smoking also increases your risk of having complications, as does having diabetes. Postoperative complications increase your chances for having graft thrombosis which is a partial or complete loss of blood flow through the graft. The most common postop complication is leg swelling with fluid drainage which can be straw-colored like urine, pink, or even red-brown like old blood. Other potential complications include bleeding, infection and graft thrombosis.

You should call the doctor immediately

  • if your surgical site becomes so swollen it is difficult to walk, or
  • if the swelling increases suddenly (over a few minutes)
  • if you have any symptoms of loss of circulation to your leg(s) such as loss of a graft pulse, cold or discolored foot, and increased pain.
You should also notify your physician if you experience any signs or symptoms of infection including:
  • redness that gets worse rather than better,
  • drainage from the wound that is like pus, and
  • fever greater than 100┬░.
You should arrange a follow-up appointment with your physician 10-14 days following surgery for staple/suture removal. You will need to call the office to arrange an appointment time. Once the incision line has healed completely, using a vitamin E ointment or a moisturizing cream may help reduce scarring.

You may notice some numbness along your incision line, or even some strange sensations with walking after surgery. This is not uncommon and often will resolve within a few weeks after surgery. Sometimes the numbness can last for months, and in some cases, may not go away. This is due to the unavoidable disruption of the nerves along the incision lines.

Your activity restrictions are minimal. If you drive, you may resume driving 1week following surgery, as long as you are no longer taking pain pills and can comfortably move your foot to and from the gas pedal and brake. After 1 week, you may gently begin to return to your normal range of motion.

You may shower 72 hours after surgery, and pat the incision lines dry.

You should expect to take 1 enteric-coated aspirin (EC aspirin) every day from now on unless specifically instructed to do otherwise. Taking 1 aspirin a day ( or the prescribed alternative) will help the graft(s) stay open and reduce the chances that you will need additional vascular surgery in the future. Sometimes Coumadin® or anti-platelet medications like Ticlid or Plavix are required, especially when a synthetic graft is used.

Maintaining blood flow through your new graft(s) will be an on-going process. You can help maintain your graft in several ways. First, don't smoke! Smoking increases the risk of graft failure, both in the short and long-term. Next, take your medications as directed. Anti-platelet agents or blood thinners help maintain graft patency. If you are diabetic, maintaining good blood sugar control will reduce the progression of new arterial plaque (plaque contributes to graft thrombosis). If your cholesterol or triglyceride levels are elevated, these should be corrected with dietary changes and, when necessary, medication.

If you have a graft pulse that can be felt with your fingers, you will need to check it daily. A loss of the graft pulse should be reported to your physician immediately.

Additional graft monitoring will be provided on a regular basis through the office with either doppler (sound waves) or duplex (sound waves with imaging) of the graft. Initially this will be every 3 months. That time interval will increase the longer your graft remains open.

Your help in following these recommendations will assist us in providing you with the best possible care for you and your new bypass graft.