[Current status of reconstructive surgery of the sub-inguinal artery]

Saphenous vein bypass is the optimal operation for arterial reconstruction in the subinguinal region. There has been no demonstrated advantage to using a devalvulated saphenous vein in situ rather than an inverted dissected vein. Prosthetic bypass may be preferred over saphenous bypass with a vein < or = 4 mm if the lower anastomosis is situated on the upper popliteal artery, if the life expectancy is short or if on the contrary the downstream bed is normal. Permeability after percutaneous transluminal angioplasty does not last as long as after bypass surgery for obliterations, but the operation is less aggressive and does not compromise a subsequent procedure. The best indications are short stenoses in patients with a long walking distance in whom surgery would be excessive. Angiography or ultrasound angioscopy after a bypass procedure or endoluminal dilatation can check the technical quality of the operation and help improve permeability duration. Adjuvant treatment such as a venous patch on a prosthetic anastomosis or various drugs are highly important in improving the duration of permeability. A prospectively planned follow-up should be an integral part of arterial reconstruction surgery in order to identify subsequent stenoses and programme their treatment before occlusion occurs.