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A femoral popliteal bypass, commonly referred to as a fem-pop bypass, is a procedure to treat blockages in the femoral artery. The femoral artery is the largest artery in the leg and supplies oxygen-rich blood to the legs and lower body. It can become blocked due to a build-up of plaque in the artery (a process known as atherosclerosis).
A fem-pop bypass uses a graft to replace the blocked artery and create a new route for your blood to flow. This diverts blood away from the blockage and improves blood supply to your legs. The graft may be made from synthetic material or from a section of a blood vessel taken from elsewhere in your body.
This page explains what a fem-pop bypass is, what happens during the procedure and what to expect during your recovery. Call or book online today to arrange a consultation to discuss a private fem-pop bypass with a consultant of your choice at Circle Health Group.
Your consultant may recommend a fem-pop bypass if the blood supply to your legs is significantly reduced due to atherosclerosis and hasn't improved with lifestyle changes and medications.
Poor circulation to your legs may cause symptoms such as:
- Pain in your calf when walking
- Foot pain when resting
- Leg pain that interferes with daily life
- Gangrene
- Wounds or infections that don’t heal
- Risk of losing your leg due to poor circulation
Alternatives to fem-pop bypass surgery include lifestyle changes such as diet and exercise and medications like statins, blood pressure medications and blood thinners.
If these treatments haven't worked, or your symptoms are getting worse and impacting your daily life, surgery is normally the next step.
The only surgical alternative to fem-pop bypass surgery is a procedure called a percutaneous transluminal angioplasty (PTA) of the femoral arteries. This is a less invasive procedure where a long, hollow tube is inserted into the femoral artery and guided to the narrowed area. A balloon is then inflated to compress the fatty deposit and widen the artery. Sometimes a mesh coil (stent) is inserted to prevent the artery from closing again.
A PTA is normally tried before fem-pop bypass surgery is considered.
At your first consultation, you will be seen by a consultant general surgeon or a consultant vascular surgeon. They will ask you about your symptoms, general health, and medical history. They may ask to see the results of any previous tests and scans, or they may arrange them on the day. They will also perform a physical examination of your legs and feet.
It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please discuss any questions and concerns with your consultant during your appointment.
At the end of your appointment, your consultant will decide if a fem-pop bypass is a suitable procedure for you based on your symptoms, diagnosis, general health, and medical history.
Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions, please call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.
Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines.
Your consultant may tell you to stop taking some medications (like blood thinners) before your operation. This is to reduce the risk of bleeding during and after your surgery.
Around a week before the procedure, you will need to attend a preoperative assessment clinic to check that you are fit enough to undergo surgery. This will include a blood test, chest X-ray and ECG.
You'll need to sign a consent form before your surgery to state that you understand all the possible risks and complications of the procedure and give your permission for the surgery to go ahead.
Check with your consultant when you can last eat or drink anything before your surgery.
What lifestyle changes can I make before my surgery?
Being in the best possible health before your surgery can reduce the risk of serious complications and speed up your recovery.
To make sure you are as healthy as possible before your surgery:
- If you smoke, you must stop at least four weeks before your fem-pop bypass. Smoking is a significant risk factor for arterial disease and increases your risk of some complications such as chest infection and poor wound healing during your recovery
- Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
- Lose weight if you need to
- Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
- Take regular exercise
Fem-pop bypass is normally performed under spinal anaesthetic which means you'll be awake for the procedure but won't feel anything from around the waist down. You may also be given a sedative to relax you and make you feel sleepy before the procedure. In some cases, you may be given a general anaesthetic.
Once the anaesthetic has taken effect, your consultant will make two incisions (cuts), one near the crease of your groin and one close to your knee. If one of your own blood vessels is being used as a graft, your surgeon will need to make other incisions, normally in your inner thigh.
Your consultant will attach one end of the graft to your femoral artery close to your groin and the other end to your popliteal artery lower down your leg. Once the new graft is in place, your consultant may use a machine called an arteriogram to check that the blood is flowing correctly through the grafted artery.
Your consultant will then close the incisions with stitches and apply a sterile dressing.
Fem-pop bypass surgery normally takes between one and five hours.
Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery or recovery. Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.
After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.
When you wake up you will have a urinary catheter (a tube in your bladder to drain urine) and a wound drain in your abdomen to drain fluid from your wound. These will be removed after a few days.
You may have some pain and discomfort in your leg for a few days after your surgery. You will be given pain medication to manage this, but please tell a member of the nursing staff if you have any pain.
How many nights will I need to stay in hospital?
Most people spend between five and seven nights in hospital after a fem-pop bypass.
Will I be able to drive home?
You will not be able to drive yourself home from the hospital after your fem-pop bypass. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.
How soon can I go back to work?
When you can go back to work after your surgery depends on the extent of the surgery you had, your individual recovery, and the type of job you do. On average, most people return to work around six weeks after fem-pop bypass surgery. Talk to your consultant about when you can expect to return to work after your fem-pop bypass.
How soon can I drive?
You should not drive until you can perform an emergency stop without pain and are no longer taking any pain medication that may make you drowsy. Check with your consultant and inform your insurance company before driving after your fem-pop bypass.
When will I be back to normal?
Recovery from any type of surgery is a gradual process that is different for everyone. You can help your recovery to go more smoothly by going at your own pace and listening to your body during your recovery. Follow your consultant's instructions carefully and call the hospital if you have any questions or concerns.
We recommend that you have someone to help you with household chores like cooking, shopping, and cleaning for at least the first few days after you get home from the hospital.
You may experience pain and discomfort in your leg for up to four weeks after your fem-pop bypass. Your consultant can prescribe pain medication to manage this.
Your healthcare team will advise you on caring for your surgical incision after your surgery. You may have dissolvable stitches, or stitches that need to be removed after around ten days. You'll be given an appointment to have them removed if this is the case. It's normal to have some bruising and swelling around your wound as well as areas of numbness and oversensitivity. These normally resolve over the next few weeks. Elevating your feet with your heels higher than your knees when sitting will help reduce swelling.
Gentle exercise such as walking is recommended during your recovery. Build up the amount you walk each day and stop if you have pain or feel tired. Speak to your consultant before engaging in more strenuous exercise or activity.
You will normally be prescribed a blood thinner such as aspirin after your fem-pop bypass. This is to help your circulation and prevent blood clots in the future. You will usually need to take this medication for the rest of your life.
Fem-pop bypass is considered major surgery and carries a risk of complications, some of which may be serious. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.
Possible complications of any surgery include:
- Bleeding
- Chest infection
- Heart attack
- Blood clots
- Adverse reactions to the anaesthetic
Possible complications specific to fem-pop bypass surgery include:
- Leakage of fluid from your surgical wound - your wound may leak clear or pink fluid. This is fairly common and should resolve over time
- Leg swelling - this normally settles after two to three months
- Numbness - you may have areas of numbness around your wound or further down your leg. This normally resolves over time, but in some cases, may be permanent
- Wound infection - an infection in your surgical wound is normally treated with antibiotics
- Bypass blockage - this is an uncommon complication where the new graft becomes blocked by a blood clot. It is treated with further surgery. You can reduce this risk by not smoking and moving around as much as possible after your surgery
- Graft failure - the graft may not function properly, and you may need another operation
- Limb loss - this is rare and occurs when the bypass blocks and blood supply is cut off causing tissue death
- Death - as with all major surgeries, there is a risk to life associated with fem-pop bypass surgery. This is very rare and partly dependent on your general health, weight, and age
Call your doctor straight away if you experience:
- Fever (a temperature above 38C)
- Redness, pain, and swelling around your incision
- Green, or yellow, strong-smelling discharge from your incision
- Changes in sensation in the affected leg such as coldness, numbness, or tingling
- Chest pain, heavy sweating, dizziness, nausea, and vomiting
At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:
- Flexible appointment times and locations that are convenient for you
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Private ensuite rooms as standard
- A range of delicious healthy meals
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to see a consultant or learn more about fem-pop bypass or any other type of vascular surgery, book your appointment online today or call a member of our team directly.
Content reviewed by Circle in-house team in May 2023. Next review due May 2026.
- Femoral Popliteal Bypass Surgery, John Hopkins
- Femoral Popliteal Bypass Surgery, Penn Medicine
