Excessive proliferation and separation of the intima in the common femoral artery mitigates against the successful performance of the proximal anastomosis in the operation of femoropopliteal vein bypass.1 The rigidity of the atherosclerotic material renders the artery inflexible and prevents adequate dilation of the arteriotomy after completion of the vein anastomosis. Full thickness sutures passing through the arterial wall drag the cut margin of the vein level with the intima. With the vein lying parallel to the artery these two factors combine to produce a kink at the heel of the anastomosis that might have hemodynamic significance (Fig 1, A and B).
A number of technical maneuvers have been suggested to overcome this problem. An elipse of artery may be excised and the anastomosis constructed with sutures passing only through the adventitio-medial plane. This obviates kinking and creates an hemodynamically acceptible anastomosis; but because the intima is left unsecured,
SAMSON ID. Femoropopliteal Vein Bypass: The Problem Proximal Anastomosis. Arch Surg. 1978;113(6):779. doi:10.1001/archsurg.1978.01370180121031