What is peripheral vascular bypass?

A peripheral vascular bypass is the surgical creation of a new route for blood to flow around narrowed or blocked arteries outside the heart. It is a treatment for peripheral artery disease (PAD). Peripheral vascular bypass involves taking healthy veins from other places in your body to replace the diseased blood vessel. Your doctor may also replace the diseased vessel with a synthetic (artificial) vessel. The newly created blood vessel is called a graft.

Peripheral vascular bypass is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a peripheral vascular bypass. 

Types of peripheral vascular bypass

The types of peripheral vascular bypass procedures include:

  • Aortic bypass is the bypass of a blocked section of your aorta. Your aorta is the main artery leaving your heart. It passes down through your abdomen (belly).
  • Axillary artery bypass is the bypass of the artery in your underarm.
  • Femoral artery bypass is the bypass of the artery in your thigh.
  • Iliac artery bypass is the bypass of the artery in your pelvis.
  • Popliteal artery bypass is the bypass of the artery in your knee.
  • Tibial artery bypass is the bypass of the artery in your lower leg. 

Other procedures that may be performed

Your doctor may perform other procedures in addition to a peripheral vascular bypass. These include:

  • Angiography, which is a procedure that allows your doctor to take a picture or image (called an arteriogram) of your artery
  • Doppler ultrasound, which produces images of the flow of blood through your artery

Why is peripheral vascular bypass performed? 

Your doctor may recommend peripheral vascular bypass to treat peripheral artery disease (PAD). PAD is a type of peripheral vascular disease (PVD). PAD is the narrowing or blockage of arteries outside your heart. 

Arteries are blood vessels that carry blood from your heart to your organs and tissues. Fatty deposits can build up on artery walls and harden into a substance called plaque. As plaque builds, it narrows and hardens the artery. This is called atherosclerosis. With time, atherosclerosis can lead to blockage of the artery and blood will not flow through it properly. In addition, a blood clot is more likely to form in an artery that has plaque buildup. Diabetes and smoking are also risk factors for PAD.

Your doctor may only consider a peripheral vascular bypass for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a peripheral vascular bypass. 

Your doctor may recommend a peripheral vascular bypass if: 

  • Medications and exercise therapy have not improved your PAD symptoms.
  • You are not a candidate for angioplasty and stenting, which opens a narrowed or blocked artery.
  • You have an infection or gangrene in the affected extremity.
  • You have pain even when resting the affected extremity.
  • You have problems performing daily activities or walking because of your PAD symptoms.
  • You have skin ulcers, sores, or wounds that will not heal on the affected extremity. You may need to have more blood flow to the area for the wounds to heal.

Who performs peripheral vascular bypass?

A vascular surgeon perform peripheral vascular bypass. Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.

How is peripheral vascular bypass performed?

Your peripheral vascular bypass will be performed in a hospital. A peripheral vascular bypass is an open surgery. Open surgery involves making an incision that allows the surgeon to directly view and treat the diseased artery. 

Your vascular surgeon will first choose and remove a suitable vein to use as a graft. If there is not a suitable vein, the surgeon will use a synthetic vessel for grafting. Your surgeon will make an incision to expose the blocked or narrowed artery. The graft is attached above and below the blockage to allow blood to flow around it. Your surgeon will verify that blood is flowing as expected through the graft by using Doppler ultrasound and angiography.