What Is an Aortobifemoral Bypass?

Written by Nicole Schmidt
Medically Reviewed by Jabeen Begum, MD on July 09, 2025
7 min read

An aortobifemoral bypass is a surgery that's done to redirect your blood flow around a large, blocked artery in your groin or abdomen. It boosts the blood flow to your legs. It's a major surgery that's usually only done if you're in danger of losing a leg or if your symptoms are severe.

To improve blood flow to your legs, your surgeon will create a new path around a blocked artery using a Y-shaped tube called a graft. Here's how the procedure works:

  1. On the day of your surgery, you'll change into a hospital gown. A nurse will place an IV in your arm so the anesthesiologist can give you general anesthesia — a medication that puts you into a deep sleep so you won't feel anything during the surgery. 
  2. Once you're asleep, your surgeon will make a cut in your belly to reach your aorta — the largest artery in your body that carries blood to your heart. They will also make two smaller cuts at the tops of your thighs to access your femoral arteries, which supply blood to your legs. 
  3. Your surgeon will use a Y-shaped graft to bypass the clogged part of your aorta. The bottom of the Y will be sewn to the healthy part of your aorta above the blockage. The two top parts of the Y are then attached to the femoral arteries below the blocked area, one on each side. This new pathway allows blood to flow from your aorta to your femoral arteries by going around the clogged area.
  4. Once the graft is in place, your surgeon will close the cuts in your belly and upper thighs using stitches or surgical staples. You'll then be moved to a recovery area where you'll be monitored until you wake up.

You may need an aortobifemoral bypass if one of the major arteries in your abdomen, pelvis, or groin is blocked by a buildup of fatty deposits on your artery walls. The aorta is the largest artery in your body. It's in your abdomen. It splits to form the iliac arteries in your pelvis. These arteries are called the femoral arteries when they reach your thighs.‌

A buildup of fatty deposits in your arteries is called atherosclerosis. It's called peripheral artery disease (PAD) when atherosclerosis affects the arteries leading to your arms, legs, stomach, or head. It usually affects the arteries leading to your legs.

If you have PAD, the tissues in your legs can't get enough oxygen due to blocked blood flow. And it might cause:

  • Pain that gets worse if you exercise
  • Sores on your legs or feet that won't heal
  • Nerve damage
  • Gangrene, which is when your tissues die because they don't get enough blood
  • Dry, itchy, scaly, or brown skin on your legs or feet
  • The need to amputate your leg

Jeffrey Siracuse, chief of vascular and endovascular surgery at Boston Medical Center, says that the benefits of aortobifemoral bypass surgery vary from person to person, depending on their symptoms.

When plaque builds up in your aorta and femoral arteries, it affects how much oxygen-rich blood can reach your legs, feet, and pelvic organs. This can cause leg pain while you're walking or even at rest. In severe cases, it can lead to gangrene — a serious condition where tissue starts to die due to a lack of blood supply.

Bypass surgery doesn't remove the plaque, but it can ease your symptoms and lower your chances of having complications later on. For some people, this means less leg pain — especially at rest — and the ability to walk longer distances. It may also help leg wounds heal more quickly.

The most serious risk of an aortobifemoral bypass is a heart attack. Other complications that can develop are:

  • Bleeding
  • Infection
  • Hematoma, which is a collection of blood outside of a blood vessel
  • Kidney problems
  • Breathing problems
  • Hernia
  • Blood clot in your leg
  • Swelling in the wall of the artery caused by a small hole
  • Aortoenteric fistula, which is an abnormal connection between the aorta and the gastrointestinal system

In the weeks or months leading up to your surgery, Siracuse says it's important to take steps to improve your overall health — including addressing factors that caused the blockages in your arteries. These changes can help your body recover faster and make the surgery more effective in the long term.

If you smoke, quitting can make a big difference. Tobacco use damages your heart and blood vessels and increases your chances of having complications after surgery. At minimum, you should stop smoking for at least three to four weeks before your surgery and continue to avoid tobacco products afterward. Quitting can make your recovery easier and lower your chances of getting cardiovascular disease later on.

Managing high cholesterol is another way to improve your outcome. Eating a heart-healthy diet, exercising, and maintaining a healthy weight can all make a difference. "Just be as healthy as you can leading up to the surgery," Siracuse says. "It will help make the operation as durable as possible."

Your doctor will give you more specific instructions as your surgery date approaches. You may need to: 

  • Adjust or stop medications temporarily. It's important to let your doctor know about all the medications and supplements you take so they can make recommendations.
  • Stop eating and drinking the night before the surgery. Your doctor will tell you when, exactly, to start fasting.
  • Have more tests to check how your heart is working and your overall health. These may include:
    • Ankle-brachial index, which compares blood pressure in your arms vs. ankles to test for peripheral artery disease
    • Vascular ultrasound 
    • Imagine tests to check your heart and coronary arteries

About 80% of people who have aortobifemoral bypass surgery get relief from their symptoms and have good blood flow through the bypass after surgery. Most people don't have pain when they're resting, and walking becomes much less painful. If you smoke, your outlook will be better if you quit smoking before the surgery and don't start back.

‌Anyone who can't have general anesthesia shouldn't have an aortobifemoral bypass. You may also be at an increased risk of complications if you have any of the following issues:

  • Significant heart disease
  • A recent stroke
  • A recent heart attack
  • Multiple previous surgeries in your abdominal area
  • Retroperitoneal fibrosis, which is a rare disease that causes fibroids in your abdominal cavity
  • End-stage kidney disease
  • A horseshoe kidney, which is when you were born with your kidneys fused together

Treatments to try before an aortobifemoral bypass 

Before you have an aortobifemoral bypass, you should try other ways to treat your peripheral artery disease, including:

  • Quitting smoking
  • Exercising regularly
  • Taking medicine to thin your blood
  • Losing weight
  • Treating your high cholesterol
  • Treating your diabetes
  • Treating your high blood pressure‌

Siracuse says if you feel pain while walking that gets better when you rest, you should always try simple treatments first before opting for surgery. "Surgery is really a symptom-based thing," he says. "It's not something you do just because you find blockages or because you see something on imaging."

You will be sore and tired for several weeks after your surgery. You'll be able to do many of your normal activities after four to six weeks. It may take you up to two to three months to fully recover. The following tips will help you take care of yourself at home: 

  • Get plenty of sleep.
  • Rest when you feel tired.
  • Try to walk a little more each day.
  • Avoid intense activities until your doctor says it's okay.
  • Avoid straining to lift anything for six weeks.
  • Follow your doctor's instructions about breathing exercises, showering, and activity.

Call your doctor if you have any of the following symptoms after surgery:

  • Fever, chills, or other signs of infection
  • Nausea or vomiting
  • Cough, shortness of breath, or chest pain
  • Redness, swelling, pain, bleeding, or discharge from your incision site
  • Pain that can't be controlled with your medicine
  • Pain or swelling in your legs or feet
  • Problems when you urinate, including pain, urgency, frequency, or bleeding
  • Legs that are pale, blue, cold, tingly, or numb

An aortobifemoral bypass can improve blood flow to your legs when other treatments haven't helped. While the surgery doesn't remove plaque buildup in your arteries, it can ease leg pain and help leg wounds heal more quickly. Taking steps to improve your overall health, such as quitting smoking and lowering your cholesterol, can support your recovery. It can help make the surgery more effective in the long run. Make sure to talk to your doctor about the potential benefits and risks of aortobifemoral bypass surgery, and ask whether a nonsurgical option might be worth trying first.

Are there alternatives to aortobifemoral bypass surgery?

Yes. Your doctor may suggest nonsurgical options first, such as making lifestyle changes or taking medications, to manage symptoms and improve your blood flow.

Can I live a normal life after aortobifemoral bypass surgery?

Yes. Most people are able to fully return to their regular routines within two to three months. After recovering from surgery, many people notice an improvement in their quality of life.

How painful is aortobifemoral bypass surgery?

You'll be asleep during surgery, so you won't feel any pain during the procedure. You may have some pain around the incision site during recovery, but your doctor will likely prescribe pain medication to help with that.

How do I know if the graft is working properly?

Your doctor will monitor your recovery and check the blood flow in your legs to make sure the graft is working properly. Let your doctor know if your legs feel cold, numb, or if you notice any other unusual symptoms.

Will aortobifemoral bypass surgery leave a scar?

Yes, you'll have scars where the cuts were made — typically along your belly and at the tops of your thighs. These should fade over time but won't disappear completely.