The Vascular Surgery team at the University of Michigan is dedicated to providing exceptional patient care in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical building.

Our surgeons have extensive experience performing bypass grafts for the treatment of peripheral vascular occlusive disease and are continuing to investigate and research new advances for treatment in this area.

What is bypass grafting?

Bypass grafting is a surgical procedure to redirect blood flow around an area of blockage. The procedure creates an alternate channel for blood flow, bypassing an obstructed or damaged vessel. The graft may come from a healthy section of the patient's own vein, or a synthetic material, such as Dacron may be used.

Bypass grafting is one of several surgical techniques used to treat peripheral vascular diseases. Other treatments may include angioplasty and/or stenting, atherectomy, or cryoplasty.

Conditions	Treatments
Bypass Grafting (also known as: peripheral vascular bypass, lower extremity bypass)	Peripheral vascular disease, peripheral artery disease, atherosclerosis

Who is a good candidate for bypass grafting?

You are a good candidate for bypass grafting if you have severe narrowing of any of your peripheral arteries and the blockage is producing a problem. For example, a blockage can occur in your leg arteries producing pain in your legs when you walk, it could be in the arteries that supply your brain making you at risk for stroke, or they could be in your kidney arteries causing severe hypertension.

U-M vascular surgeons who perform bypass grafting

For details about education, experience, and specialty in this clinical area, please visits these physician profile pages:

How do I prepare for a bypass graft?

Your doctor will give you detailed instructions as to how to prepare for the procedure. These may include a suggestion to eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. If you regularly take any important medicines, your physician may ask you to take them on the day of surgery with a sip of water.

Follow your doctor's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely experience breathing problems during surgery. Bypass grafts are adversely affected by smoking. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Other Considerations

Plan for your care and transportation after the procedure and during recovery at home.
Before surgery, your health care provider will ask you to sign a consent form for the surgery in addition to other procedures, which may become necessary in the case problems arise during the procedure and emergency surgery is needed.
You will have blood tests, and an electrocardiogram (ECG) before the procedure.
Someone at the hospital will shave and wash the area of the incisions to help prevent infection.

What happens during the procedure?

Your surgeon will work with your anesthesiologist to determine if you'll receive general or local anesthesia. General anesthesia means you'll be asleep for the duration of the procedure. Local anesthesia, which may consist of an epidural or spinal block, means you'll be awake for the procedure, but will not feel any pain or sensation.

If your own tissues will be used for the bypass, our surgeon will begin by removing the portion of the vein that will be used as the graft. Typically a portion of the saphenous vein is used. This is a vein that ruins from your foot up to your groin. If a healthy portion of the saphenous vein is unavailable, you surgeon may select an alternate vessel, or use a synthetic graft instead.

The location of the incision for a bypass graft varies depending on the location of your particular blockage, but in general, the surgeon will make an incision just above the location of the blockage to expose the artery. The artery is clamped both above and below the blockage. Starting below the blockage, your surgeon will make an incision to open the artery and will suture one end of the graft. The loose portion of the graft is then routed to the location above the blockage and the process is repeated. The clamps are removed and the bypass is carefully examined to verify there is no leakage. The surgical incision is then closed.

What happens after the procedure?

You will go back to your hospital room and rest in bed for 3 to 10 days. You can usually resume normal activity within two weeks. You will be placed on an aspirin or baby aspirin. You may be temporarily placed on a medication called Plavix™.

People with successful bypass grafting have good long-term results. A small percentage of patients will have early re-narrowing due to excessive scar formation, which may require a repeat of the procedure. This usually happens within 3 to 6 months of having the procedure. Later failures are typically due to progression of arterial disease.

What are the risks?

You may have an allergic reaction to the general anesthetic.
You may bleed a lot and need medicine or a blood transfusion.
The blockage may come back after 3 to 6 months.
Although rare, a procedure involving the brain arteries could cause a stroke.

There is risk with every treatment or procedure. Talk to your surgeon for complete information about how the risks apply to you.

How can I take care of myself following surgery?

Do not smoke.
Eat a healthy diet that is low in fat and cholesterol.
Exercise according to your health care provider's recommendation.
Keep your appointment for your scheduled post-discharge office visit.

When should I call my health care provider?

Call your health care provider right away if:

You have chest pain.
You have constant or worsening pain or numbness in your arm or leg.
You have a fever.
You have shortness of breath.
Your leg or arm becomes blue and cold.
You have bleeding, excess bruising, or a lot of swelling where the catheter was inserted.

Make an appointment or contact us for more information.