Vascular Surgery · HeartCraft

Peripheral Artery Bypass Surgery

A new route for blood around the blocked artery in your leg. Relieve pain, heal wounds and work to save your limb with a carefully planned vascular operation.

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Pain-free walking
Wound healing
Limb salvage
When to get checked

Signs your leg arteries may be blocked

Peripheral artery disease narrows the arteries that carry blood to your legs. See a vascular surgeon if you notice any of these.

Pain when walkingCramping in the calf, thigh or buttock that eases with rest (claudication).
Pain at restBurning pain in the foot or toes, often at night, relieved by hanging the leg down.
Cold, pale footA foot that feels cold or looks pale, bluish or dusky compared with the other.
Wounds that will not healSores on toes, heels or shins that heal slowly or not at all, or turn black.
Weak or missing pulseShiny skin, hair loss on the leg and a weak or absent pulse in the foot.
How bypass works

A new road for your blood

In peripheral artery bypass, the surgeon sews a graft above and below the blocked section, creating a fresh path that lets blood reach the lower leg and foot again.

Illustration for explanation only. Your operation depends on the site and length of your blockage.

Low blood flow
Disease progression

How peripheral artery disease advances

The more the blockage grows, the less blood reaches the leg. Bypass is usually considered for the later steps, when other treatment is not enough.

No symptomsArteries narrowing silently. Managed with medicines and lifestyle change.
Treatment may helpPain on walkingCramping that eases with rest. Bypass is considered if it limits daily life.
Bypass often neededPain at restConstant foot pain, a sign of severely reduced blood flow.
Urgent careWounds or gangreneTissue is not getting enough blood. Fast treatment helps avoid amputation.
Not every blocked artery needs surgery. Medicines, supervised walking, angioplasty and stenting are also options. We recommend what suits your scans and your health.
Our bypass procedures

Bypass options, chosen for your blockage

The teal line shows the route of the new graft in each operation.

Aorto-bifemoral Bypass

A Y-shaped graft runs from the main abdominal artery (aorta) to both groin arteries. Used for blockages high up in the aorta and iliac arteries.

Blockage above the groin

Femoro-popliteal Bypass

The graft goes from the thigh (femoral) artery to the artery behind the knee. The most common bypass for blockages in the thigh.

Blockage in the thigh

Femoro-distal Bypass

The graft reaches a smaller artery below the knee (tibial or peroneal) or at the ankle. Used to save the limb in severe disease with non-healing wounds.

Blockage below the knee

Femoro-femoral Crossover

A graft is tunnelled under the skin of the lower abdomen from the healthy groin artery to the blocked side, avoiding a larger operation.

One-sided iliac blockage

Axillo-femoral Bypass

The graft starts at the artery under the arm and runs down the side of the body to the groin. A good choice when the abdomen cannot be operated on safely.

For high-risk patients

Ilio-femoral Bypass

A short graft bypasses a blocked iliac artery in the pelvis and joins the artery in the groin to restore flow to the whole leg.

Blockage in the pelvis
Graft choice

Which graft is used for your bypass?

Your surgeon picks the graft after studying your scans and checking your veins.

Vein graft (your own vein)

  • Usually the great saphenous vein from the same leg
  • Generally lasts longer, especially for bypasses below the knee
  • Your own tissue, so the body accepts it well
  • Needs an extra incision to take the vein

Synthetic graft (PTFE or Dacron)

  • Man-made tube, available in many sizes
  • Used when no suitable vein is available
  • Common for larger arteries such as the aorta and above the knee
  • Needs closer follow-up and medicines to keep it open
Tests before surgery

How we map your blockage

Ankle-brachial indexCompares blood pressure in ankle and arm.
Duplex ultrasoundShows blood flow and narrowing in the leg arteries.
CT angiographyDetailed 3D map of the arteries to plan the graft.
MR or catheter angiographyUsed when more detail is needed.
Patient journey

Your treatment, step by step

Assessment and imagingExamination of pulses, ankle-brachial index, ultrasound and CT angiography to locate the blockage.
1
Getting you readyStopping tobacco, controlling sugar, blood pressure and cholesterol, and heart and lung checks.
2
Bypass surgeryUnder anaesthesia, the graft is sewn above and below the blockage. It usually takes a few hours.
3
Hospital recoveryPulse and wound checks, pain control, leg care and early walking as advised by your team.
4
Follow-up and graft checksRegular ultrasound scans, blood-thinning and cholesterol medicines, and a daily walking plan.
5
What to expect

Benefits, risks and keeping your bypass healthy

Possible benefits

  • Relief from leg pain and cramps
  • Longer, more comfortable walking
  • Healing of leg and foot wounds
  • Helps avoid amputation in severe disease

Risks to know

  • Bleeding or wound infection
  • Leg swelling after surgery
  • Graft narrowing or blockage over time
  • Heart, lung or kidney strain in some patients

Protect your graft

  • Stop smoking and all tobacco
  • Walk daily as advised
  • Control sugar, blood pressure and cholesterol
  • Check your feet every day and take your medicines
FAQ

Frequently asked questions

Is bypass the only treatment for blocked leg arteries?

No. Medicines, exercise, angioplasty and stenting can work for some blockages. Bypass is chosen when the blockage is long or severe, or when other treatment is not suitable.

How long does the surgery take?

It depends on the type of bypass, but it generally takes a few hours. Your surgeon will tell you what to expect for your case.

How long will the graft last?

This varies from person to person. Vein grafts generally last longer, and good control of smoking, sugar and cholesterol, along with regular scans, helps keep the graft open.

When can I walk after the operation?

Early walking is encouraged, with your team guiding you. Most patients build up activity step by step over the following weeks.

Do I really need to stop smoking?

Yes. Smoking is one of the main reasons grafts block and arteries narrow again, so stopping is the most important thing you can do for your bypass.

Will I feel pain after surgery?

Some soreness around the cuts is normal. Pain control is part of your care plan, and it eases as the wounds heal.

Leg pain that will not go away?

Get a vascular opinion on your scans and learn whether bypass or another treatment is right for you.

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This page is for general information and does not replace a medical consultation. Treatment depends on your individual diagnosis.
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