The aorta is the primary artery of the body. The aorta is shaped somewhat like a candy cane, with the curved part attached to the top of the heart, and the straight part extending down the middle of the body just in front of the backbone.  At about the level of the navel, the aorta divides like a "Y" into the iliac arteries, which extend down to the legs.  The "Y" area is called the aortic bifurcation, and is a very common site for the development of arterial blockage (stenosis).  Patients with blockage in this area will experience leg tightening and cramping when they walk, and may feel coldness or numbness in the feet.  In males, the lack of blood flow can cause loss of sexual function.

In many patients, medication, moderate exercise, and change in lifestyle (diet, stop smoking) will relieve the symptoms.  Patients with localized blockages can often be treated with balloon angioplasty or stent.  Severe and diffuse blockage of the aorta and iliac arteries will require a surgical procedure to restore blood flow.

Aorto-bi-femoral bypass is a type of surgery in which the diseased aorto-iliac arteries are replaced with synthetic tubes (grafts) made of special cloth or plastic material.  The material is manufactured to resemble a pair of pants; the waist is sewn to a healthy part of the aorta, and the legs are sewn to the femoral arteries in each groin, so that blood flows freely through the graft, bypassing the patient's blocked arteries.

Aorto-bifemoral bypass is a major surgical procedure that requires incisions in the abdomen and both legs.  Patients are usually hospitalized for 5-8 days after surgery, and need several weeks to recuperate at home.   When performed by properly trained and well-qualified vascular surgeons, the operation is highly successful in 90-95% of patients.