VASCULAR & THORACIC SURGERY Procedure

Infrainguinal Saphenous Vein Arterial Bypass Surgery

Infragenicular autologous saphenous vein or Dacron/ePTFE synthetic bypass grafting (Femoral-Popliteal / Femoral-Distal Tibial Bypass) restoring lower limb arterial blood supply in critical limb ischemia.

Peripheral vascular bypass surgery

Clinical Overview & Disease Information

Signs & Symptoms

Early Symptoms

• Intermittent claudication (cramping calf pain when walking 100 meters, relieved by rest)
• Coldness and diminished pulse in lower foot

Common Symptoms

• Ischemic rest pain (severe forefoot burning pain keeping patient awake at night)
• Non-healing arterial ulceration on toes/heel
• Dry black gangrene of toes

Emergency Symptoms

• Acute limb ischemia with sudden loss of sensation, motor function, and absent pulses

Causes & Risk Factors

Primary Causes & Etiology

Severe diffuse atherosclerotic occlusive disease of superficial femoral / popliteal arteries
Long-standing poorly controlled diabetes mellitus & hypertension
Heavy cigarette smoking

Who is at Higher Risk?

Patients with critical limb-threatening ischemia (CLTI) facing amputation without bypass

Diagnostic Evaluation & Testing

Diagnostic Test	Clinical Purpose / What It Shows
Ankle-Brachial Index (ABI < 0.4) & Toe Brachial Index (TBI)	Quantifies severity of arterial perfusion impairment
Contrast CT Angiography Lower Limbs & Digital Subtraction Angiography (DSA)	Maps inflow arterial patent segment, bypass conduit, and distal target runoff vessels

Comprehensive Treatment Options

Autologous Reverse / In-Situ Greater Saphenous Vein Femoral-Popliteal Bypass

Microsurgical end-to-side arterial anastomosis grafting reversed autologous vein from common femoral artery to below-knee popliteal or tibial artery.

Key Advantages:

Superior 5-year graft patency (> 80-85%) compared to synthetic grafts

Saves limb from major above/below knee amputation

Restores direct inline triphasic blood flow to foot

Femoral Endarterectomy & ePTFE Synthetic Bypass with Vein Cuff

Surgical plaque removal and synthetic graft placement.

Recommended For:

Patients lacking suitable autologous saphenous vein conduit

Advanced Medical Technologies Available in Partner Hospitals

Autologous Saphenous Vein Conduit ePTFE Vascular Graft with Heparin Bonding Intraoperative Doppler Flowmetry

Possible Complications If Untreated

Graft thrombosis (< 5%)

Wound lymphatic leak (seroma)

Transient leg edema

Recovery Timeline, Diet & Lifestyle Care

Recovery Timeline

Procedure / Stage	Expected Recovery Duration
Vascular ICU / Ward Monitoring	24 to 48 hours
Supported Ambulation & Discharge	4 to 7 days
Full Wound Healing & Limb Salvage	4 to 6 weeks

Essential Lifestyle Changes

Strict 100% smoking cessation (critical to prevent graft occlusion)
Daily walking exercise program
Inspect feet daily for minor cuts

When to Contact a Doctor Urgently:

Sudden severe leg pain, coldness, or numbness (Graft Thrombosis warning)

High fever

Wound discharge

Prevention & Long-Term Health

Complete smoking cessation, aggressive statin therapy, and walking exercise

Frequently Asked Questions

Can peripheral bypass surgery prevent leg amputation?

Yes, peripheral bypass surgery restores blood flow to ischemic limbs and successfully prevents amputation in over 85-90% of critical limb ischemia cases.