BYPASS SURGERY
(FEMOROPOPLITEAL & FEMORODISTAL)
Vascular bypass surgery in London
What is vascular bypass surgery?
Vascular bypass surgery is a procedure in which a new pathway - a graft - is created to route blood around a blocked or severely narrowed artery, restoring adequate blood flow to the leg and foot. It is one of the most effective treatments for advanced peripheral arterial disease and is a cornerstone of limb salvage surgery in patients with critical limb ischaemia.
Professor Zayed has extensive experience in bypass surgery for the lower limb, including femoropopliteal bypass (bypassing blockages in the thigh) and femorodistal bypass (extending the bypass to the vessels below the knee and at the ankle). These are technically demanding procedures requiring precision and expertise, particularly in patients with diabetes or calcified vessels.
Who needs bypass surgery?
Bypass surgery is typically considered when:
• Peripheral arterial disease has progressed to critical limb ischaemia - causing rest pain, non-healing wounds, or gangrene - and the limb is at risk of amputation
• The pattern of arterial disease (long or complex blockages, multiple-level disease) is not suited to endovascular (keyhole) treatment
• A previous endovascular procedure has failed or the vessel has re-narrowed
• Severe claudication is significantly limiting quality of life and has not responded to other treatments
The decision between endovascular treatment and open bypass is made on an individual basis, taking into account the anatomy of the disease, the patient's overall fitness for surgery, and the availability of a suitable vein for grafting.
Types of bypass surgery
Femoropopliteal bypass
In femoropopliteal bypass, a graft is used to connect the femoral artery in the groin to the popliteal artery behind the knee (above-knee bypass) or just below the knee (below-knee bypass), bypassing blockages in the superficial femoral artery running through the thigh. This is the most commonly performed lower limb bypass procedure and is used primarily for patients with incapacitating, life-limiting claudication or critical ischaemia affecting the calf and foot.
Femorodistal bypass
When the arterial disease extends into the vessels below the knee - as is commonly the case in patients with diabetes - a longer bypass is required, connecting the femoral artery to the tibial or peroneal arteries in the lower leg, or even to vessels at the level of the ankle (pedal bypass). These distal bypasses require meticulous surgical technique and the use of the patient's own vein as a conduit wherever possible.
Aortobifemoral and axillobifemoral bypass
For patients with disease affecting the aorta and iliac arteries (aortoiliac occlusive disease), Professor Zayed also performs aorto-bifemoral bypasses - connecting the aorta to both femoral arteries via a Y-shaped synthetic graft - and axillo-femoral bypass, an extra-anatomic alternative for patients who are not fit for aortic surgery
What is the graft made of?
Autologous vein graft (preferred)
The best long-term results in lower limb bypass surgery are achieved using the patient's own saphenous vein - the long vein running from the groin to the ankle on the inner aspect of the leg. Vein grafts are more resistant to infection and have superior long-term patency rates compared to synthetic alternatives, particularly for below-knee bypasses.
Synthetic grafts
Where a suitable vein is not available - due to previous harvest, varicose changes, or inadequate calibre - a synthetic graft (polytetrafluoroethylene, or PTFE) may be used. Synthetic grafts perform acceptably for above-knee bypasses but have lower patency rates than vein in below-knee positions.
The procedure and recovery
Bypass surgery is performed typically under general anaesthetic and its duration depends on the complexity of the procedure. Most patients require a hospital stay of three to five days, during which appropriate blood thinning medications is commenced to protect the graft and physiotherapy begins.
Recovery at home typically takes four to six weeks, with most patients returning to light activities within this period. Lifelong antiplatelet therapy is usually prescribed, and regular outpatient follow-up with duplex ultrasound surveillance of the graft is performed to detect any early signs of narrowing and allow timely intervention before the graft fails.
Frequently asked questions
Book a consultation with Professor Zayed
To discuss your vascular condition or arrange a private consultation at one of Professor Zayed's clinics, please use the contact form or call the practice directly. Appointments are typically available within one to two weeks, with urgent slots for time-sensitive referrals.
