Arterial bypass grafting

Early surgery involved mainly thrombo-endarterectomy - the open removal of atheromatous plaques and organised surface thrombosis from the aorta and iliac vessels - but is less popular now because of the complexity of the operation and the time involved.

Arterial bypass grafting is the current method of choice. Synthetic graft materials such as Dacron - woven polyester - have replaced the original homografts. Commonly performed grafts include those for aorto-iliac disease, in which the infrarenal and common femoral arteries are connected just below the inguinal ligament, and those for femoro-popliteal disease, in which the long saphenous vein is used to connect the common femoral and popliteal arteries.

Complications of this approach include:

• generalised arteriopathy - myocardial infarction, stroke, renal failure and intestinal ischaemia
• haemorrhage
• thrombosis in the connected vessels
• embolism into vessels (renal or limb)
• false aneurysm formation
• infection of the graft