Bypass graft, with vein; femoral-femoral
CPT4 code
Name of the Procedure:
Bypass Graft with Vein; Femoral-Femoral
Common Names: Fem-Fem Bypass, Femoral-Femoral Bypass, Fem-Fem Graft
Summary
The femoral-femoral bypass graft is a surgical procedure that creates a new pathway for blood flow between the femoral arteries in each leg. It uses a segment of a vein from the patient or a synthetic graft to bypass a blocked section of one of the femoral arteries, ensuring adequate blood supply to both legs.
Purpose
Medical Condition:
The procedure is primarily used to treat peripheral artery disease (PAD) or severe blockages in the femoral artery.
Goals:
- Restore proper blood flow to the legs.
- Alleviate symptoms such as pain, cramping, and non-healing ulcers.
- Prevent tissue damage or loss due to inadequate blood supply.
Indications
Symptoms:
- Claudication (leg pain during exercise)
- Critical limb ischemia (rest pain, ulcers, or gangrene)
- Non-healing wounds on the legs or feet
Patient Criteria:
- Significant blockage in the femoral artery unresponsive to other treatments.
- Adequate blood flow in the donor artery (the opposite femoral artery).
Preparation
Instructions:
- Fasting for at least 8 hours before the procedure.
- Stopping blood thinners or other medications as directed by the doctor.
- Arranging for someone to drive you home post-procedure.
Diagnostic Tests:
- Ultrasound or angiography to assess blood flow and locate blockages.
- Blood tests to evaluate overall health.
Procedure Description
- Anesthesia: General anesthesia or spinal/epidural anesthesia is typically used.
- Incisions: Small incisions are made over each femoral artery.
- Graft: A vein, usually from the patient's leg, or a synthetic graft is used to connect the two femoral arteries.
- Connection: The graft is sutured into place, creating a new route for blood to bypass the blockage.
- Closure: The incisions are closed with sutures or staples.
Duration
The procedure typically takes 2 to 4 hours.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Vascular surgeon
- Surgical nurses
- Anesthesiologist
- Operating room technicians
Risks and Complications
- Common: Infection, bleeding, blood clots, graft occlusion.
- Rare: Nerve damage, reactions to anesthesia, limb loss, heart attack, stroke.
- Management: Postoperative monitoring, antibiotics, anticoagulants.
Benefits
- Improved blood flow to the legs.
- Relief from pain associated with PAD.
- Enhanced ability to walk and perform daily activities.
- Prevention of severe complications such as tissue death.
Recovery
Post-Procedure Care:
- Pain management with prescribed medications.
- Keeping incisions clean and dry.
- Monitoring for signs of infection or other complications.
Recovery Time:
- Hospital stay of 1-3 days.
- Gradual return to normal activities over 4 to 6 weeks.
- Follow-up appointments to monitor graft function.
Alternatives
- Angioplasty/Stenting: Less invasive but may not be suitable for all blockages.
- Conservative Management: Lifestyle changes and medications, generally less effective in severe cases.
- Other Bypass Procedures: Depending on the location and severity of blockages.
Patient Experience
During the procedure, the patient is under anesthesia and does not feel pain. Postoperatively, there may be some discomfort at the incision sites, managed effectively with pain relief measures. Gradual improvement in symptoms is expected over weeks, with significant lifestyle improvements as circulation is restored. Regular follow-up ensures any complications are promptly addressed.