The first part of the operation involves administering an anaesthetic. The majority of leg bypasses are performed under general anaesthesia (with you asleep). Occasionally a leg bypass may be performed under a spinal anaesthetic where an injection into your back numbs you from the waist down for the duration of the procedure. In our experience, clients prefer, and find it more comfortable, to undergo a leg bypass under general anaesthesia. Once you have been anaesthetised you will have a tube (catheter) inserted into your bladder to drain your urine. This facilitates accurate assessment of your hydration status during and immediately after the operation. Occasionally the anaesthetist will decide to insert a small tube into an artery in your wrist to enable accurate measurement of your blood pressure during your operation. Once the necessary monitoring equipment has been connected your surgeon will start the operation. At Circulation Clinic we undertake all leg bypasses as joint cases with two of our consultant surgeons operating together. This reduces the time taken to perform the operation and thereby the time you are under general anaesthesia. We strongly believe this improves outcomes and reduces the risk of a variety of potential complications including heart attacks, kidney failure, respiratory complications and infection rates. For a femoro-below knee popliteal bypass one surgeon will expose the femoral artery through a 5-10cm vertical incision in the groin. At the same time, the second surgeon will expose the below knee popliteal artery through a similar length incision on the inner aspect of the calf. The pre-marked vein is then harvested through a number of small incisions on the inner aspect of your thigh and calf. The vein is then removed from your leg and assessed for integrity. The femoral artery is then opened (arteriotomy) and cleared of any disease (endarterectomy). In a number of cases the blood flow into the femoral artery is affected by disease in the pelvic arteries. If this is deemed to be insufficient to sustain a bypass your surgeons may elect to perform an angioplasty +/- stenting of the pelvic (iliac) arteries to improve the blood flow into the femoral artery. Once adequate flow has been established into the femoral artery, one end of the vein graft is joined (anastomosed) to the femoral artery using permanent stitches. The vein graft is then tunnelled through the leg and joined to the below knee popliteal artery creating the leg bypass. The wounds are repaired in layers with stitches. A drain is often inserted into the wounds to drain any excess fluid that may accumulate in the immediate post-operative period. The leg is then dressed with absorbent adhesive dressings.