Lower Extremity Percutaneous Arterial Bypass

A bypass is a surgical technique in which a pathway is created to circumvent an artery that has been damaged by arteritis. The procedure is used to restore normal blood flow both above and below the damaged area.

Lower extremity arterial bypass was first described in 1948, when it was performed in Paris by a surgeon named Jean Kunlin on a 54-year-old male patient. Since then, arterial bypass has become widespread around the world and remains practically unchanged today.

In 2013, the Interventional Radiology team at the American Hospital of Paris developed a percutaneous technique (with no surgical incision) to perform arterial bypass procedures.

This innovative method is indicated when traditional revascularization techniques (angioplasty or surgical bypass) are unsuccessful. Using this technique, we have spared around one hundred patients from a lower extremity amputation.

Unlike a surgical bypass procedure, percutaneous bypass can be performed under local anesthesia, with light sedation. It does not require a surgical incision, as the opening necessary to insert the stent is only about 3 mm wide.

As in open surgical bypass procedures, a new arterial pathway is created by connecting a healthy artery – not affected by arteritis – to a lower artery (often the popliteal artery located behind the knee). The bypass is performed using a PTFE-coated stent to divert the blood from one artery to another. The material that coats the stents is the same as that used to coat the implants used in traditional vascular surgery.

Percutaneous bypass is a groundbreaking technique used in vascular surgery and interventional radiology. Initial outcomes report a minimized recovery time and near-invisible scar.

The percutaneous bypass technique uses the same materials as open surgery (with an incision), thereby ensuring compatibility, and possible complementarity, between the two approaches.

During a consultation, the interventional radiologist explains the procedure and the associated medications and provides all necessary information to the patient.

A consultation is then scheduled with the anesthesiologist, who will propose the most appropriate anesthesia for each patient. Light sedation is generally recommended for this procedure.

Patients must fast prior to the procedure. About an hour before the actual procedure begins, a local anesthesia is administered to the groin area. The bypass is then performed jointly by two interventional radiologists.
The anesthesiologist stays in the room for the duration of the procedure.

a and b: Arteries prior to the bypass. The patient underwent two previous surgical bypass operations.
c: View of the connection between two vascular structures during a procedure.
d and e: Verification of the bypass performed instants earlier.

Once the bypass procedure is over, the patient is taken to the post-anesthesia care unit for two to four hours. The patient is then accompanied to their room, where they are required to stay in bed until the next morning.

The next morning, the patient is allowed to get up. A Doppler or CT angiography will be performed to ensure the bypass was a success.

The patient can go home after the interventional radiologist does a final check.

This novel technique is indicated once it has been validated during a consultation by the interventional radiologist, who will also take into consideration all of the traditional revascularization options available to patients with limb-threatening disorders (chronic pain and/or ulcers).

International scientific literature reports that percutaneous bypass procedures lead to a limb-salvage rate of more than 80%. A wound healing rate of over 70% after one year has also been observed.

These outcomes were achieved on patients who were to undergo an amputation – without percutaneous bypass – because other traditional techniques were not possible.