Bypass graft, with vein; femoral-popliteal
CPT4 code
Name of the Procedure:
Bypass graft, with vein; femoral-popliteal
Common Name(s): Femoral-Popliteal Bypass Surgery, Fem-Pop Bypass
Technical Term: Autologous Vein Bypass Grafting
Summary
The femoral-popliteal bypass surgery involves using a vein from another part of the patient's body to create a new pathway for blood flow around a blocked artery in the upper leg. This helps restore proper blood circulation to the lower leg and foot.
Purpose
Medical Condition Addressed: Peripheral Artery Disease (PAD), ischemia in the lower extremities
Goals: To improve blood flow, alleviate symptoms like pain and cramps, prevent limb loss, and enhance walking ability.
Indications
Symptoms & Conditions: Severe leg pain during walking (claudication), non-healing leg wounds, rest pain, gangrene, or ulceration of the lower extremity.
Patient Criteria: Patients with significant arterial blockages not responsive to other treatments, good general health to undergo surgery, and no contraindications for anesthesia.
Preparation
Pre-Procedure Instructions: Patients may need to fast for 8-12 hours before the procedure. Certain medications (e.g., blood thinners) might need to be adjusted or halted as per doctor's advice.
Diagnostic Tests: Blood tests, electrocardiogram (ECG), ankle-brachial index (ABI) test, duplex ultrasound, and angiography to assess the extent of blockage.
Procedure Description
- Anesthesia: The patient is given general or regional anesthesia.
- Incisions: Incisions are made in the upper thigh (near the femoral artery) and near the knee (popliteal artery).
- Vein Harvest: A vein, often the saphenous vein from the patient's leg, is harvested.
- Bypass Creation: The vein is sutured to create a new pathway around the blocked artery sections.
- Closure: The incisions are closed with sutures or staples, and dressings are applied.
Tools & Equipment: Surgical scalpels, retractors, suturing equipment, vein harvesting tools, and hemostats.
Duration
The procedure typically takes 2-4 hours.
Setting
Performed in a hospital's operating room.
Personnel
Surgeons: Vascular or cardiovascular surgeons. Other Healthcare Professionals: Anesthesiologists, surgical nurses, and technicians.
Risks and Complications
Common Risks: Infection, bleeding, blood clots, or graft failure.
Rare Risks: Heart attack, stroke, or nerve damage.
Management: Monitoring and medications to manage pain, bleeding, or clotting.
Benefits
Expected Benefits: Improved blood flow in the leg, pain relief, increased mobility, and prevention of limb amputation. Realization Time: Benefits can be seen shortly after recovery but may continue to improve over weeks to months.
Recovery
Post-Procedure Care: Pain management, keeping surgical sites clean, and avoiding heavy lifting. Expected Recovery Time: Around 4-8 weeks, with possible physical therapy. Restrictions & Follow-Up: Regular follow-up appointments, lifestyle changes, and medication adherence are essential.
Alternatives
Other Treatments: Angioplasty with or without stent placement, medication management, supervised exercise programs. Pros and Cons: Angioplasty is less invasive but may not be as effective for long segments of blocked arteries. Medication and exercise can improve symptoms but may not address severe blockages.
Patient Experience
During Procedure: Under general anesthesia, the patient will be unconscious; with regional anesthesia, only the leg will be numbed. After Procedure: Soreness and discomfort which can be managed with prescribed painkillers. Possible mild to moderate pain during initial recovery, gradually subsiding over time. Comfort measures include rest and ice packs to reduce swelling.