Arteriosclerotic occlusive disease of the lower extremities is characteristically segmental in nature, although the locations and patterns of involvement may be multiple and varied.2,4,5 Combined disease of the aortoiliac and femoropopliteal arteries is frequently seen in patients with vascular insufficiency of the lower extremities. Ideal surgical management should have as its aim restoration of normal blood flow to the common femoral and profunda femoris vasculature as well as to the distal segments composed of the popliteal and tibial arteries. The technique we have found generally most satisfactory for this purpose is aorta-to-femoral-to-popliteal artery bypass graft in continuity with side-to-side anatomosis in the femoral region between the graft and the common femoral artery (Fig. 1).
Certain factors, however, may make this ideal type of revascularization impossible in some cases or unwise when technically feasible in others. For one thing, the popliteal, anterior tibial, and posterior tibial arteries may be extensively