Lower limb artery surgery

Lower limb artery surgery treats advanced peripheral arterial disease — blocked arteries that no longer supply the leg with enough blood. It is indicated for patients with disabling intermittent claudication, pain at rest, wounds that will not heal or gangrene, and its purpose is to save the limb and relieve the symptoms. The interventions include ilio-femoral and femoro-popliteal bypass, endarterectomy and widening angioplasty.

Lower limb artery surgery at a glance

• Condition treated: peripheral arterial disease (peripheral vascular disease)
• Indications: disabling intermittent claudication, pain at rest, non-healing ulcers, gangrene
• Interventions: ilio-femoral and femoro-popliteal bypass, endarterectomy, widening angioplasty with or without a stent
• What is at stake: restoring the circulation and saving the limb

When is leg artery surgery necessary?

Peripheral arterial disease appears when fatty deposits narrow the arteries and the blood flow drops; the lower limbs are the most affected by this type of vascular condition. Surgery becomes necessary in the stages where the disease threatens the limb:

• disabling intermittent claudication — pain when walking that severely limits daily activity
• pain at rest, at first at night, then permanently
• ulcers that will not heal
• gangrene

Details about the disease, symptoms, diagnosis and conservative treatment are on the Arterial conditions page.

Ilio-femoral and distal bypass

Ilio-femoral bypass with an associated distal bypass (or iliodistal bypass) can be indicated when the surgeon wants to limit the extent of the procedure and avoid approaching the contralateral femoral artery, in the context of unilateral multi-level disease.

Indications

In cases of occlusive disease of the iliac or proximal common femoral artery, there are several options when patients present symptoms of claudication or, more rarely, limb-threatening ischaemia (non-healing ulcers, gangrene). Additional indications include an isolated iliac aneurysm and a proximal common femoral aneurysm.

Femoro-popliteal bypass

The superficial femoral artery is the main nutrient artery of the calf and the foot. When an arterial stenosis appears gradually, the body develops a collateral substitution network, which for a while ensures the normal oxygenation of the calf and the foot. Atheromatous disease is responsible for the arterial lesions that, over time, exceed this compensation.

How does the intervention work?

The surgical procedure is performed by bypassing the diseased segment of the artery, using a synthetic graft. The blood is redirected through the new route towards the areas that were no longer properly supplied, which relieves the symptoms and saves the limb at risk.

Endarterectomy

Endarterectomy is one of the common surgical interventions doctors can use to treat narrowed arteries, improve the blood flow and relieve the symptoms of peripheral arterial disease. The intervention involves removing the fatty substances called plaque from inside the arteries.

If the artery in the upper part of the leg — the common femoral artery — has a blockage or a severe narrowing, an endarterectomy at this level may be necessary.

Widening angioplasty

Angioplasty is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, usually to treat arterial atherosclerosis. It restores the blood flow without open surgery and can be performed even in emergency situations.

The technique

A deflated balloon, attached to a catheter (a balloon catheter), is passed over a guide wire into the narrowed vessel and then inflated to a fixed size. The balloon forces the expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent can be introduced at the moment of ballooning, to make sure the vessel stays open; the balloon is then deflated and withdrawn. Full details on the Endovascular surgery (angioplasty and stenting) page.

Frequently asked questions

What happens if peripheral arterial disease is not treated?

The disease progresses: the pain appears over ever shorter distances, then also at rest, and in the final stages ulcers and gangrene appear, with a risk of amputation. Timely treatment — from lifestyle and medication to revascularisation — prevents these complications.

Classic surgery or angioplasty?

It depends on the location and extent of the lesions and on the patient’s risk: short lesions often respond to angioplasty with stenting, while extensive ones may require a bypass. The decision is taken after arteriography or CT angiography.

What is the graft used in a bypass?

It is the “conduit” that bypasses the diseased segment: either a synthetic prosthesis or a portion of vein harvested from the patient. The choice depends on the level of the lesion and on the quality of the patient’s own vessels.

Can amputation be avoided?

The purpose of these interventions is precisely to save the limb. The earlier the revascularisation is performed — before extensive gangrene sets in — the greater the chances of saving the leg.