In our experience, many instances of late failure after grafting operations for femoropopliteal occlusive disease have been due to incomplete correction of the obliterative process at the popliteal level.1 On scrutinizing the operative details of these cases, we have observed, moreover, that the incompleteness of the surgical procedure was the result of one of two circumstances: Often the disease was too far advanced to have been completely circumvented by any means; in such situations no operative technical factor could be implicated. In a significant number of cases, however, the corrective operations had to be stopped short of the optimal distal level, owing to the impossibility of exposing the distal reaches of the involved arterial tree through the conventional femoral incision. The obvious technical maneuver to overcome this problem Was the division of the angioplastic procedure into two steps: obtaining access to the upper femoral artery through a standard thigh
SZILAGYI DE, WHITCOMB JG, SMITH RF. Anteromedial Approach to the Popliteal Artery for Femoropopliteal Arterial Grafting. AMA Arch Surg. 1959;78(4):647–651. doi:10.1001/archsurg.1959.04320040141028
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