Name of the Procedure:

Bypass Graft, with Other Than Vein; Femoral-Femoral

• Common Names: Fem-Fem Bypass, Femoral-Femoral Bypass
• Technical Term: Femoral-Femoral Arterial Bypass

Summary

A femoral-femoral bypass is a surgical procedure that involves creating a bypass between the femoral arteries in both legs using a synthetic graft (instead of a vein). This helps improve blood flow to the leg with poor circulation.

Purpose

The procedure is designed to address blocked or narrowed arteries in the lower extremities, specifically in cases where the femoral artery is obstructed.

Goals:

• Restore adequate blood flow to the affected leg.
• Alleviate symptoms like pain and cramping.
• Prevent complications such as ulcers or gangrene.

Indications

• Peripheral artery disease (PAD) with severe symptoms.
• Limb ischemia resulting in pain, tissue damage, or non-healing wounds.
• Previous vascular interventions that have failed.
• Severe atherosclerosis affecting blood flow to the legs.

Preparation

• Patients may be instructed to fast for 8-12 hours before the procedure.
• Medications may need adjustment, particularly blood thinners.
• Diagnostic tests like angiography, ultrasound, or CT scans to assess the vascular system.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incisions: Two incisions are made – one in each groin area.
3. Preparation of Arteries: The femoral arteries are exposed.
4. Graft Placement: A synthetic graft is tunneled under the skin from one femoral artery to the other.
5. Attachment: The graft is sewn into place on the arteries.
6. Closure: The incisions are closed with sutures or staples.

• Tools/Equipment: Synthetic graft material, surgical instruments, anesthesia equipment.
• Anesthesia: General or spinal anesthesia is commonly used.

Duration

The procedure typically takes around 2-4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Scrub Technicians

Risks and Complications

• Infection at the incision sites.
• Blood clots or bleeding.
• Graft infection or failure.
• Allergic reactions to anesthetics.
• Rare risks: Kidney failure, heart attack.

Benefits

• Improved blood flow to the affected leg.
• Reduction or elimination of pain.
• Enhanced ability to perform daily activities.
• Prevention of severe complications like gangrene.

Recovery

• Hospital stay of 3-5 days post-surgery.
• Pain management with medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for monitoring graft function.
• Recovery time ranges from a few weeks to a couple of months.

Alternatives

• Angioplasty with stenting: A less invasive procedure involving the placement of a stent to keep the artery open.
• Endarterectomy: Surgical removal of plaque from the artery.
• Bypass using vein graft: Uses a vein from the patient’s body instead of a synthetic graft.

Pros and Cons:

• Angioplasty: Faster recovery, but less effective for severe blockages.
• Endarterectomy: Effective but more invasive than angioplasty.
• Vein Graft: Can be more durable, but not suitable for all patients.

Patient Experience

• During the procedure, the patient will be under anesthesia and won’t feel anything.
• Post-surgery: Pain and discomfort managed with medication.
• Gradual return to activities with specific guidelines provided by the healthcare team.
• Regular follow-up for graft surveillance and health monitoring.