Thromboendarterectomy combined with femoropopliteal bypass

Most complications that appear within 5-6 weeks after femoropopliteal bypass (FPB) are associated with the surgical procedure in the groin. Destruction of lymphatic structures in the presence of an open foot infection and crushing of the intima by clamping the common and deep femoral arteries are significant predisposing factors in producing early infection or occlusion of the graft. To avoid these predisposing factors, a combined procedure of a short thromboendarterectomy of the proximal superficial femoral artery and an autogenous or prosthetic bypass graft was used, without application of clamps to the common and deep femora arteris. In a series of 45 patients, this combined procedure was used and a significant reduction of complications was achieved. Indications, technique, and advantages of this combined method are discussed.