For some patients the minimally invasive angiography and intervention option is not feasible or not appropriate. For some of these patients, lower extremity arterial bypass may be the best option. Using a natural or synthetic graft, blood is routed around an area of blockage. This involves making an incision above the blockage and below the blockage and may involve additional incisions to remove the vein that is used as the natural graft for the bypass.

There are at least two incisions that will need to heal. Through the top incision, the inflow artery is exposed and a connection made between the artery and the graft using fine stitches. Through the second incision, which is made further down the leg, a similar connection is made to the artery below the blockage.

There will be associated soreness and discomfort. Initially, assistance with walking will be required. The recovery for bypass surgery is much different than from angiography. As this is an open surgical approach and there are incisions involved, the surgery must be performed in the hospital and usually involves a 2 to 4 night stay. Occasionally, an additional period of recuperation at a skilled nursing facility is appropriate. Wound infection and blood loss as well as heart attack and pneumonia are risks of open surgery.