Surgery for Aortoiliac Occlusive Disease

Your doctor may perform a leg bypass surgery if you have large arterial blockages and severe symptoms. This surgery may be performed if a less invasive procedure doesn’t improve symptoms, or if a minimally invasive procedure isn’t possible, such as when the blockage is very long or crosses over a joint such as the hip or knee.

Your doctor may recommend this surgery if you have intermittent claudication, or pain when walking. It’s most commonly used for people with gangrene or skin ulcers on the leg. You may also need this procedure if you have a pulmonary embolism, a blood clot in the leg that breaks loose and travels through the bloodstream to an artery in the lungs, causing a potentially life-threatening blockage. 

Performed using general or local anesthesia, leg bypass surgery allows the surgeon to create a new route for blood to travel around the blocked artery. This restores blood flow to the leg and prevents the need for amputation, which may be necessary when a body part is affected by gangrene. 

During a leg bypass, the surgeon makes an incision in the leg, then selects and removes a healthy vein to serve as a bypass graft for the blocked artery. Next, the surgeon clamps the vein and makes an incision near the blocked portion of the artery. He or she opens the artery and connects one end of the vein graft with permanent stitches. Then the doctor clamps and opens the artery above the blockage and connects the other end of the graft. 

After the procedure, the doctor ensures the bypass is functioning properly by using Doppler ultrasound to evaluate blood flow in the artery.

The procedure typically requires a hospital stay of 3 to 10 days. Stitches are removed from the incisions one to two weeks after surgery. During this time, your surgeon may prescribe an antiplatelet medication to prevent blood clots from forming around the bypass site.

If the blockage appears in the femoral artery, which extends from the iliac artery into the leg, your doctor may perform a common femoral artery endarterectomy, in which he or she removes the plaque causing the blockage. Sometimes, doctors perform an endarterectomy on blockages to the iliac artery in the pelvis. The procedure is performed with general anesthesia.

Your surgeon makes an incision in the abdomen or leg, temporarily clamps and then opens the artery with an incision, and removes plaque, the waxy substance blocking blood flow to the lower body. Then, he or she uses stitches to close the incisions in the artery and the skin. 

The surgery takes about three to four hours and typically requires a four to seven day hospital stay. You can likely resume normal activities within six to eight weeks.